@Article{info:doi/10.2196/67051, author="Lindhiem, Oliver and Tomlinson, S. Claire and Kolko, J. David and Silk, S. Jennifer and Hafeman, Danella and Wallace, Meredith and Setiawan, Agus I. Made and Parmanto, Bambang", title="Novel Smartphone App and Supportive Accountability for the Treatment of Childhood Disruptive Behavior Problems: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="11", volume="14", pages="e67051", keywords="mobile health", keywords="disruptive behaviors", keywords="parent management training", keywords="randomized controlled trial", keywords="externalizing behavior", abstract="Background: Although evidence-based treatments have been developed for childhood behavior problems, many families encounter barriers to treatment access and completion (eg, local availability of services, transportation, cost, and perceived stigma). Smartphone apps offer a cost-efficient method to deliver content to families. Objective: The aim of this study is to evaluate the effectiveness of the UseIt! mobile health system as both stand-alone and coach-assisted interventions via a randomized controlled trial. The UseIt! System is designed to reduce disruptive behaviors in young children. Methods: A nationwide sample of parents of children aged 5 years to 8 years with disruptive behaviors (N=324 dyads) are randomly assigned to the stand-alone app (UseIt!; n=108), the coach-assisted app (UseIt! plus supportive accountability; n=108), or the control app (mindfulness app; n=108). The UseIt! App provides parents with tools and troubleshooting to address disruptive behaviors, along with a behavior diary to track behaviors and strategies over time. The coach-assisted condition includes a bachelor's level paraprofessional who provides weekly phone calls to promote engagement with the app. The control condition is composed of a mindfulness app. The web-based, self-assessed outcome measures (post treatment and 6-month follow-up) include measures of app usage, parenting knowledge (eg, knowledge of parent management training and cognitive behavioral therapy skills), and strategies (use of evidence-based parenting strategies), symptom reduction (eg, behavior problems), and parent mental health (eg, anxiety, stress, and depression). We hypothesize that both intervention conditions will show greater parent knowledge and use of skills along with greater symptom reduction relative to the control condition. Further, we hypothesize that those assigned to the coach assisted condition will report greater knowledge, skill use, and symptom reduction than the stand-alone app. We will use intent-to-treat analyses to regress outcomes on study conditions to evaluate for differences across conditions. Results: Recruitment of study participants began in December of 2022 and is ongoing. We have recruited over half of our intended sample of 324 parent-child dyads (n=214) as of December 2024. These dyads have been randomly allocated to each of the intervention conditions, with 71 assigned to the coach-assisted condition, 72 assigned to the stand-alone app, and 71 assigned to the control app condition. Data collection is projected to be completed by late 2026. Conclusions: The current study aims to address a gap in the literature regarding the feasibility, effectiveness, and utility of a smartphone app that includes a coach-assisted arm. Digital therapeutics have the potential to enhance the reach and scalability of skills-based psychosocial interventions. Findings from this study will advance scientific knowledge and have implications for clinical practice. Trial Registration: ClinicalTrials.gov NCT05647772; https://clinicaltrials.gov/study/NCT05647772 International Registered Report Identifier (IRRID): DERR1-10.2196/67051 ", doi="10.2196/67051", url="https://www.researchprotocols.org/2025/1/e67051" } @Article{info:doi/10.2196/63799, author="Liu, Yujie and Ge, Xin and Wang, Ying and Yang, Xue and Liu, Shangbin and Xu, Chen and Xiang, Mi and Hu, Fan and Cai, Yong", title="Urban-Rural Differences in the Association Between Internet Use Trajectories and Depressive Symptoms in Chinese Adolescents: Longitudinal Observational Study", journal="J Med Internet Res", year="2025", month="Feb", day="7", volume="27", pages="e63799", keywords="internet use", keywords="trajectory", keywords="depressive symptoms", keywords="adolescent", keywords="urban", keywords="rural", abstract="Background: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas. Objective: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas. Methods: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence. Results: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8\%) and the high-growth group (n=229, 10.2\%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95\% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95\% CI 1.164-2.959). Conclusions: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents' internet use behaviors to mitigate negative effects on their mental health. ", doi="10.2196/63799", url="https://www.jmir.org/2025/1/e63799" } @Article{info:doi/10.2196/65471, author="Chen, Shu-Cheng and Lo, Kwai-Ching and Li, Han and Wong, Pong-Ming and Pang, Lok-Yi and Qin, Jing and Yeung, Wing-Fai", title="Parental Experiences of Administering Pediatric Tuina for Sleep and Appetite in Early School-Aged Children With Attention-Deficit/Hyperactivity Disorder: Qualitative Study in Hong Kong", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="30", volume="8", pages="e65471", keywords="pediatric massage", keywords="child", keywords="traditional Chinese medicine", keywords="TCM", keywords="ADHD", keywords="qualitative study", keywords="complementary medicine", keywords="attention deficit", keywords="hyperactivity", keywords="massage", keywords="tuina", keywords="tui na", keywords="mental health", keywords="sleep", keywords="appetite", keywords="parent", keywords="parenting", keywords="interview", keywords="focus group", keywords="anmo", keywords="attention-deficit/hyperactivity disorder", abstract="Background: Previous research suggested that parent-administered pediatric tuina could improve symptoms of attention-deficit/hyperactivity disorder (ADHD), such as sleep quality and appetite. Objective: This study aimed to explore the experiences and perceptions of parents administering pediatric tuina to school-aged children with ADHD in Hong Kong. Methods: This qualitative study was embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for improving sleep and appetite in school-aged children diagnosed with ADHD. Purposive sampling was used to invite 12 parents who attended a pediatric tuina training program and delivered the intervention to their children at home for at least 8 weeks. Data were collected through semistructured focus group interviews and individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Two main themes emerged: (1) effects of parent-administered pediatric tuina and (2) parents' experience of administering pediatric tuina. Parents reported significant improvements in children's sleep quality, appetite, behavior, mental state, and academic performance. Facilitators provided professional guidance and applied a user-friendly course design. Challenges included difficulties in mastering techniques, locating acupuncture points, and time management. Participants suggested the need for more traditional Chinese medicine pattern diagnostic sessions, real-time supervision methods, and extended follow-up to better observe long-term effects. Conclusions: Parent-administered pediatric tuina was perceived to improve children's sleep quality and appetite significantly, along with other aspects of well-being. Professional guidance and a structured training program facilitated implementation, and challenges highlighted the need for more frequent diagnostic sessions, real-time supervision, and extended follow-up. Trial Registration: ClinicalTrials.gov NCT06007742; https://clinicaltrials.gov/study/NCT06007742 ", doi="10.2196/65471", url="https://pediatrics.jmir.org/2025/1/e65471" } @Article{info:doi/10.2196/66496, author="Amsalem, Doron and Greuel, Merlin and Liu, Shuyan and Martin, Andr{\'e}s and Adam, Maya", title="Effect of a Short, Animated Storytelling Video on Transphobia Among US Parents: Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="20", volume="11", pages="e66496", keywords="public health communication", keywords="vulnerable population", keywords="stigma reduction", keywords="stigma", keywords="transphobia", keywords="transgender", keywords="gender diverse", keywords="LGBTQ", keywords="parent", keywords="mental health", keywords="mental illness", keywords="transgender children", keywords="children", keywords="youth", keywords="adolescent", keywords="storytelling", keywords="animation", abstract="Background: Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35\% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents' affirmation of their children's gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality. Objective: Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents. Methods: We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer, before and after watching the video. We compared outcomes between the two groups using 2 {\texttimes} 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child. Results: Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores (F2,1=3.7, P=.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention (F1=27.4, P<.001). Effect sizes (Cohen d) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point. Conclusions: Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive. Trial Registration: AsPredicted.org 159248; https://aspredicted.org/ptmd-3kfs.pdf ", doi="10.2196/66496", url="https://publichealth.jmir.org/2025/1/e66496" } @Article{info:doi/10.2196/60042, author="Radley, Jessica and Penhallow, Jessica and Wickersham, Alice and Morris, Anna and Colling, Craig and Downs, Johnny", title="Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="26", volume="7", pages="e60042", keywords="child mental health", keywords="caregivers", keywords="digital technology", keywords="digital health", keywords="technology use", keywords="digital skill", keywords="digital literacy", keywords="digital divides", keywords="online systems", keywords="online survey", keywords="pediatric", keywords="mental health", keywords="usability", keywords="platform", keywords="survey", keywords="questionnaire", keywords="children", keywords="youth", keywords="adolescent", keywords="informal care", keywords="family care", keywords="acceptability", keywords="System Usability Scale", keywords="SUS", keywords="mobile phone", abstract="Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the ``virtual waiting room'' module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45\% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98\%) used a mobile phone to access myHealthE, and many had not accessed the platform's full functionality, including the new ``virtual waiting room'' module. Household income was a significant predictor of caregivers' levels of comfort using technology; caregivers were 13\% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95\% CI 1.00?1.29). Themes generated from caregivers' feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual's needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. ", doi="10.2196/60042", url="https://pediatrics.jmir.org/2024/1/e60042" } @Article{info:doi/10.2196/57154, author="Mabaso, Siza Wakithi and Hein, Sascha and Pavarini, Gabriela and and Fazel, Mina", title="Exploring the Relationship Between Public Social Media Accounts, Adolescent Mental Health, and Parental Guidance in England: Large Cross-Sectional School Survey Study", journal="J Med Internet Res", year="2024", month="Dec", day="17", volume="26", pages="e57154", keywords="social media", keywords="adolescent health", keywords="privacy", keywords="parental guidance", keywords="mood disorders", keywords="adolescent", keywords="anxiety", keywords="depression", keywords="cross-sectional", keywords="mental health", keywords="public", keywords="account", keywords="school-going", keywords="school", keywords="England", keywords="survey", keywords="logistic regression", keywords="observational", abstract="Background: Although associations between social media use and adolescent mental health have been described, more information is needed on the potential components characterizing this complex exposure, in particular, those related to maintaining a public social media account. Objective: This study aims to investigate the association between having a public social media account and anxiety and depression in school-going adolescents. Methods: Overall, 80 secondary schools and further education colleges in England were sampled using a cross-sectional web-based survey as part of the 2023 OxWell Student Survey. Social media exposure was categorized among the adolescents as having a public social media account versus not having a public social media account. The risk of clinical anxiety and depression was determined using the Revised Child Anxiety and Depression Scale-11. Adolescents self-reported the content and platforms accessed in the previous 24 hours. Associations between having a public social media account and symptoms of anxiety and depression were assessed using logistic regression controlling for age, sex, the experience of being bullied, parental guidance of online behavior (describing perceived parental approaches to adolescents' online activity), the proportion of close friendships engaged with online, poverty status, and placement in statutory care. Age, sex, and parental guidance of online behavior were assessed for primary association effect modification. Results: Data collected from 16,655 adolescents (aged 11-18 y) were analyzed. Of these 16,655 adolescents, 6734 (40.43\%) had a public social media account, while 9921 (59.57\%) either had a private social media account or no social media account. Moreover, 32.6\% (5429/16,655) of the adolescents screened positive for symptoms of anxiety and depression. Those with a public social media account had higher odds of anxiety and depression (odds ratio [OR] 1.41, 95\% CI 1.32-1.50) than those without a public social media account in an unadjusted and fully adjusted model (OR 1.39, 95\% CI 1.29-1.49). Adolescents reporting active parental guidance had lower odds of anxiety and depression (OR 0.85, 95\% CI 0.75-0.93) than those reporting no parental guidance, and these parental approaches to online behaviors significantly modified the association between having a public social media account and symptoms of anxiety and depression (P=.004; $\chi$22=11.1). Conclusions: Our OxWell study findings suggest a potential mental health risk for adolescents with a public social media account. We show evidence indicating some protection from anxiety and depression among adolescents who do not have a public social media account and those reporting some form of parental guidance of their online behavior. This was pronounced in adolescents reporting active parental guidance compared to stricter regulatory approaches or no guidance at all. The specific roles that social media account choices and parental guidance of online behavior may play in supporting the mental health of adolescents are highlighted for further investigation. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-052717 ", doi="10.2196/57154", url="https://www.jmir.org/2024/1/e57154", url="http://www.ncbi.nlm.nih.gov/pubmed/39688898" } @Article{info:doi/10.2196/59696, author="Zhao, Yanan and Fan, Huiyun and Luo, Yanan and Zhang, Rong and Zheng, Xiaoying", title="Gender Inequalities in Employment of Parents Caring for Children With Autism Spectrum Disorder in China: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="17", volume="7", pages="e59696", keywords="autism spectrum disorder", keywords="family", keywords="employment status", keywords="influencing factors", keywords="autism", keywords="child care", keywords="children", keywords="China", keywords="parent", keywords="online survey", keywords="mother", keywords="father", keywords="adolescent", keywords="youth", keywords="ASD", keywords="children with autism", abstract="Background: The increasing need for child care is placing a burden on parents, including those with children with autism. Objective: The aim of this study was to examine the employment status of Chinese mothers and fathers with children with autism spectrum disorder (ASD), as well as to investigate the factors that affected their employment decisions. Methods: An online national survey was completed by the parents of 5018 children and adolescents with ASD aged 2-17 years (4837 couples, 181 single mothers, and 148 single fathers). The dependent variable was employment status---whether they kept working or quit to take care of their child. The independent variables were those characterizing the needs of the child and the sociodemographic characteristics of the family. Results: The employment rate of mothers with children and adolescents with ASD was 37.3\% (1874/5018), while 96.7\% (4823/4988) of fathers were employed. In addition, 54.3\% (2723/5018) of mothers resigned from employment outside the home to care for their children, while only 2.8\% (139/4988) of fathers resigned due to caring obligations. Mothers' employment was positively associated with their single marital status, lower educational level, and having assistance from grandparents. Having the grandparents' assistance was positively associated with fathers' employment. Conclusions: Gender inequalities in employment exist in China. Mothers caring for children with ASD had lower workforce participation than fathers. More female-friendly policies and a stronger gender equality ideology would be of benefit to Chinese society. ", doi="10.2196/59696", url="https://pediatrics.jmir.org/2024/1/e59696" } @Article{info:doi/10.2196/49305, author="Backman, Anna and Roll-Pettersson, Lise and Mellblom, Are and Norman-Claesson, Elisabet and Sundqvist, Emma and Zander, Eric and Vigerland, Sarah and Hirvikoski, Tatja", title="Internet-Delivered Psychoeducation (SCOPE) for Transition-Aged Autistic Youth: Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="28", volume="26", pages="e49305", keywords="autism", keywords="internet based", keywords="young adult", keywords="intervention", keywords="digital communication", keywords="life satisfaction", keywords="codeveloped", keywords="ASD", keywords="autism spectrum disorder", keywords="autistic", keywords="RCT", keywords="randomized controlled trial", keywords="randomized", keywords="psychoeducation", keywords="patient education", abstract="Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants' understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module's topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants' autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: --0.13, 95\% CI --1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363 ", doi="10.2196/49305", url="https://www.jmir.org/2024/1/e49305" } @Article{info:doi/10.2196/60604, author="Horita, Hideki and Seki, Yoichi and Yamaguchi, Takumi and Shiko, Yuki and Kawasaki, Yohei and Shimizu, Eiji", title="Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="3", volume="7", pages="e60604", keywords="internet addiction", keywords="adolescents", keywords="parents", keywords="cognitive behavioral therapy", keywords="digital health", abstract="Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent's problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46\%) or the waitlist control group (n=7, 54\%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents' hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46\%) at week 0 to 56.2 (SD 25.1; 5/9, 56\%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54\%) to 68.0 (SD 18.7; 4/9, 44\%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 ", doi="10.2196/60604", url="https://pediatrics.jmir.org/2024/1/e60604", url="http://www.ncbi.nlm.nih.gov/pubmed/39361415" } @Article{info:doi/10.2196/54051, author="W{\"a}hnke, Laura and Dose, Christina and Klemp, Marie-Theres and M{\"u}hlenmeister, Judith and Pl{\"u}ck, Julia and D{\"o}pfner, Manfred", title="The Relationship Between Symptom Change and Use of a Web-Based Self-Help Intervention for Parents of Children With Externalizing Behavior Disorders: Exploratory Study", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="4", volume="7", pages="e54051", keywords="web-based self-help", keywords="eHealth", keywords="parent management training", keywords="externalizing symptom", keywords="ADHD", keywords="attention-deficit hyperactivity disorder", keywords="self-help", keywords="use", keywords="child", keywords="children", keywords="parent", keywords="parents", keywords="management", keywords="management training", keywords="symptom", keywords="symptoms", keywords="caregiver", keywords="ODD", keywords="oppositional defiant disorder", keywords="treatment", keywords="web-based", keywords="caregivers", keywords="longitudinal data", abstract="Background: Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers' use of WASH and symptom changes of child externalizing behaviors is lacking. Objective: This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children's externalizing behavior symptoms. Methods: Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers' use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers' use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling). Results: Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms. Conclusions: The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers' use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors). Trial Registration: German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-2481-0 ", doi="10.2196/54051", url="https://pediatrics.jmir.org/2024/1/e54051" } @Article{info:doi/10.2196/63220, author="Zhu, Shimin and Hu, Yuxi and Wang, Ruobing and Qi, Di and Lee, Paul and Ngai, Wa So and Cheng, Qijin and Wong, Ching Paul Wai", title="Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Aug", day="30", volume="13", pages="e63220", keywords="implicit theory", keywords="fixed mindset", keywords="mental health", keywords="secondary school students", keywords="belief in change", abstract="Background: Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children's affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child's internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Objective: Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children's academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. Methods: A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Results: Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. Conclusions: This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/63220 ", doi="10.2196/63220", url="https://www.researchprotocols.org/2024/1/e63220" } @Article{info:doi/10.2196/50978, author="Landman, Benjamin and Khoury, Elie and Cohen, Alicia and Trebossen, Vincent and Michel, Alexandre and Lefebvre, Aline and Delorme, Richard", title="Acceptance of a French e--Mental Health Information Website (Cl{\'e}Psy) for Families: A Web-Based Survey", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="15", volume="7", pages="e50978", keywords="mental health education", keywords="children", keywords="family", keywords="child", keywords="pediatrics", keywords="pediatric", keywords="mental health", keywords="parent", keywords="parents", keywords="parenting", keywords="psychiatry", keywords="website", keywords="acceptance", keywords="patient education", keywords="online information", keywords="health information", keywords="ease of use", keywords="usefulness", keywords="survey", keywords="surveys", keywords="user", keywords="experience", keywords="questionnaire", keywords="questionnaires", keywords="families", abstract="Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children's difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, Cl{\'e}Psy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3\%) or with their relatives (n=260, 82.1\%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. ", doi="10.2196/50978", url="https://pediatrics.jmir.org/2024/1/e50978" } @Article{info:doi/10.2196/46735, author="Jia, Yang Xiao and Andreou, Pantelis and Brown, Cary and Constantin, Evelyn and Godbout, Roger and Hanlon-Dearman, Ana and Ipsiroglu, Osman and Reid, Graham and Shea, Sarah and Smith, M. Isabel and Zwicker, D. Jennifer and Weiss, K. Shelly and Corkum, Penny", title="An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="12", volume="12", pages="e46735", keywords="eHealth intervention", keywords="pediatric insomnia", keywords="neurodevelopmental disorders", keywords="attention-deficit/hyperactivity disorder", keywords="autism spectrum disorder", keywords="cerebral palsy", keywords="fetal alcohol spectrum disorder", keywords="economic evaluation", keywords="cost-effectiveness", abstract="Background: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. Objective: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. Methods: The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. Results: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. Conclusions: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. Trial Registration: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003 International Registered Report Identifier (IRRID): DERR1-10.2196/46735 ", doi="10.2196/46735", url="https://www.researchprotocols.org/2023/1/e46735", url="http://www.ncbi.nlm.nih.gov/pubmed/37698915" } @Article{info:doi/10.2196/47409, author="Scholze, A. Danielle and Gosdin, M. Melissa and Perez, L. Susan and Schweitzer, B. Julie", title="Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Sep", day="11", volume="7", pages="e47409", keywords="ADHD", keywords="pediatric", keywords="adult", keywords="mobile phone", keywords="developmental disorder", keywords="neurodevelopmental", keywords="mental disorder", keywords="information-seeking", keywords="information need", keywords="attention deficit disorder", keywords="hyperactive", keywords="hyperactivity", keywords="interview", keywords="focus group", keywords="think-aloud", keywords="web-based", keywords="online content", keywords="user experience", keywords="information behavior", keywords="web design", abstract="Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child's needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. Objective: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. Methods: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. Results: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. Conclusions: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format. ", doi="10.2196/47409", url="https://formative.jmir.org/2023/1/e47409", url="http://www.ncbi.nlm.nih.gov/pubmed/37695648" } @Article{info:doi/10.2196/33806, author="She, Rui and Zhang, Youmin and Yang, Xue", title="Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study", journal="JMIR Serious Games", year="2022", month="Nov", day="8", volume="10", number="4", pages="e33806", keywords="internet gaming disorder", keywords="adolescents", keywords="parental factors", keywords="longitudinal study", keywords="parenting", keywords="gaming", keywords="gaming disorder", keywords="health intervention", keywords="treatment", keywords="mental health", abstract="Background: Parents play central roles in adolescents' socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8\% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4\% (148/1200) and 11.7\% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support ($\beta$=--.06, P=.02) and parental abuse ($\beta$=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control ($\beta$=.03, P=.25) and a positive relationship with parents ($\beta$=--.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. ", doi="10.2196/33806", url="https://games.jmir.org/2022/4/e33806", url="http://www.ncbi.nlm.nih.gov/pubmed/36346660" } @Article{info:doi/10.2196/38543, author="Litt, M. Dana and Geusens, Femke and Seamster, Abby and Lewis, A. Melissa", title="A Parent-Based Intervention for Reducing High-risk Social Media Cognitions, Alcohol Use, and Negative Consequences Among Adolescents: Protocol for a Randomized Controlled Pilot Study", journal="JMIR Res Protoc", year="2022", month="May", day="17", volume="11", number="5", pages="e38543", keywords="parent-based interventions", keywords="alcohol", keywords="pilot study", keywords="social media", keywords="mobile phone", abstract="Background: The prevalence of adolescent alcohol use continues to be a public health concern. Although adolescents spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescents. Extensive research in this area has resulted in parent-based intervention (PBI) efforts to prevent or reduce adolescent alcohol use. However, one major limitation of PBIs is that they do not currently consider the large role that social media plays in adolescents' lives and in relation to their alcohol use. We will add to the literature by developing and refining a web-based PBI designed to reduce both high-risk social media cognitions and alcohol use among adolescents. Objective: The central goal of the proposed study is to develop, refine, and pilot a web-based PBI to reduce both high-risk social media cognitions and alcohol use among adolescents. Methods: A total of 100 parent-teen dyads will be randomly assigned to one of the following 2 conditions: intervention or control. Parents in the intervention group will be given access to the web-based PBI and suggestions for working through the PBI modules with their teens. The parent-teen dyads will fill out 3 questionnaires: a baseline questionnaire, 1-month questionnaire, and 6-month questionnaire. Results: Recruitment and enrollment will begin in August 2022. Upon completion of the intervention trial, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed web-based PBI. Conclusions: This study has the potential to open doors for future studies examining the clinical implications of an efficacious web-based PBI to reduce alcohol use and high-risk cognitions about alcohol displays on social media. Trial Registration: ClinicalTrials.gov NCT04333966; https://clinicaltrials.gov/ct2/show/NCT04333966 International Registered Report Identifier (IRRID): PRR1-10.2196/38543 ", doi="10.2196/38543", url="https://www.researchprotocols.org/2022/5/e38543", url="http://www.ncbi.nlm.nih.gov/pubmed/35579931" } @Article{info:doi/10.2196/32693, author="Shimabukuro, Shizuka and Daley, David and Endo, Takahiro and Harada, Satoshi and Tomoda, Akemi and Yamashita, Yushiro and Oshio, Takashi and Guo, Boliang and Ishii, Atsuko and Izumi, Mio and Nakahara, Yukiko and Yamamoto, Kazushi and Yao, Akiko and Tripp, Gail", title="The Effectiveness and Cost-effectiveness of Well Parent Japan for Japanese Mothers of Children With ADHD: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="19", volume="11", number="4", pages="e32693", keywords="ADHD", keywords="parent training", keywords="Japan", keywords="New Forest Parent Programme", keywords="parent stress management", abstract="Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents. Objective: This pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. Methods: Mothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention. Results: Study funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic. Conclusions: This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270 International Registered Report Identifier (IRRID): DERR1-10.2196/32693 ", doi="10.2196/32693", url="https://www.researchprotocols.org/2022/4/e32693", url="http://www.ncbi.nlm.nih.gov/pubmed/35438647" } @Article{info:doi/10.2196/34987, author="Silva, Wnurinham and Virtanen, Eeva and Kajantie, Eero and Sebert, Sylvain", title="Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2022", month="Apr", day="14", volume="11", number="4", pages="e34987", keywords="preterm birth", keywords="birth weight", keywords="siblings", keywords="cognitive", keywords="mental health", keywords="quality of life", keywords="family", abstract="Background: Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings. Objective: The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence. Methods: This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate. Results: This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence. Conclusions: The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021222887 International Registered Report Identifier (IRRID): DERR1-10.2196/34987 ", doi="10.2196/34987", url="https://www.researchprotocols.org/2022/4/e34987", url="http://www.ncbi.nlm.nih.gov/pubmed/35436229" } @Article{info:doi/10.2196/26438, author="Korpilahti-Leino, Tarja and Luntamo, Terhi and Ristkari, Terja and Hinkka-Yli-Salom{\"a}ki, Susanna and Pulkki-R{\aa}back, Laura and Waris, Otto and Matinolli, Hanna-Maria and Sinokki, Atte and Mori, Yuko and Fukaya, Mami and Yamada, Yuko and Sourander, Andre", title="Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study", journal="J Med Internet Res", year="2022", month="Apr", day="13", volume="24", number="4", pages="e26438", keywords="adolescent", keywords="anxiety", keywords="child", keywords="cognitive behavioral therapy", keywords="coping", keywords="COVID-19", keywords="Internet", keywords="mental health", keywords="parents", keywords="web-based", abstract="Background: The COVID-19 pandemic has had a major impact on families' daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children's anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let's Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6\%) completed the program's 7 themes, and 189 (31.4\%) completed the postintervention survey. Most (138/189, 73.0\%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6\%) and their children's anxiety (157/189, 83.1\%). The majority (157/189, 83.1\%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0\%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. ", doi="10.2196/26438", url="https://www.jmir.org/2022/4/e26438", url="http://www.ncbi.nlm.nih.gov/pubmed/35138265" } @Article{info:doi/10.2196/30668, author="Davies, M. Sian and Jardine, Jenni and Gutridge, Kerry and Bernard, Zara and Park, Stephen and Dawson, Tom and Abel, M. Kathryn and Whelan, Pauline", title="Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e30668", keywords="digital mental health", keywords="acceptability", keywords="feasibility", keywords="child and adolescent mental health and well-being", keywords="school-based mental health care", keywords="prevention", keywords="digital assessment and monitoring", keywords="reading screening or ability", abstract="Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6\%) consented and took part; of these 34 children, all 34 (100\%) completed the baseline Lexplore assessment, and 30 (88\%) completed the follow-up. In addition, most children were classified by Lincus as regular (?1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. ", doi="10.2196/30668", url="https://formative.jmir.org/2021/12/e30668", url="http://www.ncbi.nlm.nih.gov/pubmed/34898446" } @Article{info:doi/10.2196/29687, author="Petrenko, McGee Christie Lynn and Kautz-Turnbull, Christine Carson and Roth, Rose Alicia and Parr, Elizabeth Jennifer and Tapparello, Cristiano and Demir, Utku and Olson, Carmichael Heather", title="Initial Feasibility of the ``Families Moving Forward Connect'' Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e29687", keywords="fetal alcohol spectrum disorders", keywords="fetal alcohol syndrome", keywords="intervention", keywords="mobile health", keywords="mHealth", keywords="parenting", keywords="children", keywords="prenatal alcohol", keywords="digital health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84\% (38/45) of caregivers and 94\% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67\% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers' stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. ", doi="10.2196/29687", url="https://formative.jmir.org/2021/12/e29687", url="http://www.ncbi.nlm.nih.gov/pubmed/34860661" } @Article{info:doi/10.2196/26842, author="Lilja, Lotten Josefine and Rupcic Ljustina, Mirna and Nissling, Linnea and Larsson, Caroline Anna and Weineland, Sandra", title="Youths' and Parents' Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="1", volume="4", number="4", pages="e26842", keywords="internet", keywords="CBT", keywords="cognitive behavioral therapy", keywords="adolescents", keywords="parents", keywords="anxiety", keywords="primary care", keywords="mixed methods", keywords="experiences", keywords="youths", keywords="digital health", abstract="Background: Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people's interest in internet treatment or the attitudes they and their parents have toward it. Objective: This study aims to investigate adolescents' and parents' attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects. Methods: The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment. Results: The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms ($\chi$22=8.333; P=.02) and that adolescents' motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths' need for autonomy while also engaging with them in the treatment work. Conclusions: Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist's role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment. ", doi="10.2196/26842", url="https://pediatrics.jmir.org/2021/4/e26842", url="http://www.ncbi.nlm.nih.gov/pubmed/34723830" } @Article{info:doi/10.2196/29454, author="Exner-Cortens, Deinera and Baker, Elizabeth and Gray, Shawna and Fernandez Conde, Cristina and Rivera, Ramirez Rocio and Van Bavel, Marisa and Vezina, Elisabeth and Ambrose, Aleta and Pawluk, Chris and Schwartz, D. Kelly and Arnold, D. Paul", title="School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review", journal="JMIR Ment Health", year="2021", month="Sep", day="21", volume="8", number="9", pages="e29454", keywords="suicide", keywords="risk assessment", keywords="youth", keywords="eHealth", keywords="school mental health", keywords="mobile phone", abstract="Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature---consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former's focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. ", doi="10.2196/29454", url="https://mental.jmir.org/2021/9/e29454", url="http://www.ncbi.nlm.nih.gov/pubmed/34546178" } @Article{info:doi/10.2196/26203, author="Hwang, Juwon and Toma, L. Catalina", title="The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents' Problematic Internet Use: Moderation Analysis", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26203", keywords="problematic internet use", keywords="PIU", keywords="subjective mental well-being", keywords="perceived parental supportiveness", keywords="adolescents", keywords="well-being", keywords="young adult", keywords="internet", keywords="mental health", keywords="support", keywords="parent", keywords="engagement", keywords="social media", abstract="Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents' subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents' engagement in PIU. Objective: This paper aimed to examine the role played by adolescents' perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology \& Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4\% (2130/4592) female and 66.9\% (3370/4592) White. Findings revealed that, controlling for adolescents' demographics and social media use, higher levels of perceived parental supportiveness ($\beta$=--.285, P<.001) and higher levels of subjective mental well-being ($\beta$=--.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being ($\beta$=--.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents' mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents' mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. ", doi="10.2196/26203", url="https://mental.jmir.org/2021/9/e26203", url="http://www.ncbi.nlm.nih.gov/pubmed/34524093" } @Article{info:doi/10.2196/29538, author="Sung, Y. Jenna and Mumper, Emma and Schleider, Lee Jessica", title="Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation", journal="JMIR Ment Health", year="2021", month="Jul", day="6", volume="8", number="7", pages="e29538", keywords="acceptability", keywords="adolescent mental health", keywords="adolescent", keywords="anxiety", keywords="avoidance", keywords="behavior", keywords="child mental health", keywords="children", keywords="digital mental health", keywords="intervention", keywords="mental health", keywords="parent", keywords="prevention", keywords="young adult", abstract="Background: A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions---particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children---for instance, by mitigating known anxiety risk factors---remains unexplored. Objective: This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods: In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results: Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration: ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9 ", doi="10.2196/29538", url="https://mental.jmir.org/2021/7/e29538", url="http://www.ncbi.nlm.nih.gov/pubmed/34255718" } @Article{info:doi/10.2196/24896, author="Liverpool, Shaun and Edbrooke-Childs, Julian", title="A Caregiver Digital Intervention to Support Shared Decision Making in Child and Adolescent Mental Health Services: Development Process and Stakeholder Involvement Analysis", journal="JMIR Form Res", year="2021", month="Jun", day="15", volume="5", number="6", pages="e24896", keywords="digital health intervention", keywords="caregivers", keywords="parents", keywords="child mental health", abstract="Background: Parents and caregivers are generally recognized by literature and the law as key to child and adolescent mental health decisions. Digital interventions are increasingly being used to support care and treatment in child and adolescent mental health services (CAMHS). However, evidence of the design and development process is generally not made available. Objective: In light of calls for more transparency, this paper aims to describe the development of an evidence-based, theoretically informed digital decision support intervention for parents and caregivers of young people accessing CAMHS. Methods: The intervention was developed in line with the UK Medical Research Council framework for developing complex interventions. The process incorporated the steps for developing patient decision aids, as follows: assessing need, assessing feasibility; defining objectives; identifying the framework of decision support; and selecting the methods, designs, and dissemination approach. We synthesized theory, research, international guidelines, and input from relevant stakeholders using an iterative design approach. Results: The development steps resulted in Power Up for Parents, a decision support intervention, with five key features (ie, decisions, goals, journey, support, and resources). The intervention aims to encourage discussion, allow parents to ask questions during sessions or seek further information between sessions, and allow service providers to tailor the shared decision-making process to accommodate the needs of the parent and child. Conclusions: We confirmed that it is possible to use input from end users---integrated with theory and evidence---to create digital interventions to be used in CAMHS. Key lessons with implications for practice, policy, and implementation science, along with preliminary findings, are presented. International Registered Report Identifier (IRRID): RR2-10.2196/14571 ", doi="10.2196/24896", url="https://formative.jmir.org/2021/6/e24896", url="http://www.ncbi.nlm.nih.gov/pubmed/34128821" } @Article{info:doi/10.2196/25047, author="Al Azdi, Zunayed and Islam, Khaleda and Khan, Amir Muhammad and Khan, Nida and Ejaz, Amna and Khan, Ahmar Muhammad and Warraitch, Azza and Jahan, Ishrat and Huque, Rumana", title="Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="May", day="4", volume="10", number="5", pages="e25047", keywords="mental health", keywords="refugee health", keywords="early childhood development", keywords="Rohingya", keywords="Bangladesh", keywords="community health care", keywords="community health worker", abstract="Background: Thousands of Rohingya refugee mothers at the world's largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers' mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox's Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention's acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention's sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 ", doi="10.2196/25047", url="https://www.researchprotocols.org/2021/5/e25047", url="http://www.ncbi.nlm.nih.gov/pubmed/33944793" } @Article{info:doi/10.2196/25235, author="Liverpool, Shaun and Edbrooke-Childs, Julian", title="Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children's and Young People's Mental Health: Mixed Methods Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Mar", day="2", volume="5", number="3", pages="e25235", keywords="mental health", keywords="pilot projects", keywords="child", keywords="adolescent", keywords="parents", keywords="shared decision making", abstract="Background: Interventions to involve parents in decisions regarding children's and young people's mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. Objective: This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children's and young people's mental health. Methods: A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children's and young people's mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents' anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial. Results: Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50\% (6/12) of the sites successfully recruited participants, and only 38\% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention. Conclusions: Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984. International Registered Report Identifier (IRRID): RR2-10.2196/14571 ", doi="10.2196/25235", url="https://formative.jmir.org/2021/3/e25235", url="http://www.ncbi.nlm.nih.gov/pubmed/33650973" } @Article{info:doi/10.2196/26567, author="Kuriyan, Aparajita and Kinkler, Grace and Cidav, Zuleyha and Kang-Yi, Christina and Eiraldi, Ricardo and Salas, Eduardo and Wolk, Benjamin Courtney", title="Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2021", month="Feb", day="8", volume="10", number="2", pages="e26567", keywords="teams", keywords="Team Strategies and Tools to Enhance Performance and Patient Safety", keywords="school mental health", keywords="school health", abstract="Background: Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective: The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods: Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results: Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions: This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration: ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID): DERR1-10.2196/26567 ", doi="10.2196/26567", url="https://www.researchprotocols.org/2021/2/e26567", url="http://www.ncbi.nlm.nih.gov/pubmed/33555258" } @Article{info:doi/10.2196/22494, author="Shin, Yu-Bin and Kim, Jae-Jin and Kim, Hyunji and Kim, Soo-Jeong and Eom, Hyojung and Jung, Hoon Young and Kim, Eunjoo", title="Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App", journal="JMIR Serious Games", year="2021", month="Jan", day="18", volume="9", number="1", pages="e22494", keywords="internet gaming disorder", keywords="family conflict", keywords="coping behavior", keywords="virtual reality", abstract="Background: Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others. Objective: This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls. Methods: In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents' perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one's gaming behavior. Results: The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients' gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training. Conclusions: The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others). ", doi="10.2196/22494", url="http://games.jmir.org/2021/1/e22494/", url="http://www.ncbi.nlm.nih.gov/pubmed/33459603" } @Article{info:doi/10.2196/18004, author="Dodds, Lynn Robin", title="Helping Optimize Language Acquisition (HOLA) Online Parent Training Modules for Latinx Parents of Toddlers at Risk for ASD: Protocol for a Pilot Funded by the Organization for Autism Research", journal="JMIR Res Protoc", year="2020", month="Dec", day="10", volume="9", number="12", pages="e18004", keywords="autism spectrum disorders", keywords="cultural diversity", keywords="parent training", keywords="pivotal response treatment", keywords="health disparities", keywords="online training", keywords="autism", keywords="intervention delay", keywords="online learning", keywords="pediatrics", abstract="Background: Culturally competent parent training in evidence-based intervention for autism spectrum disorder (ASD) can provide young Latinx children from underserved communities with early interventional support while they wait for professional services, thus reducing the impact of intervention delays. Providing parents with brief bilingual training in Pivotal Response Treatment (PRT) is a strategy that can overcome these barriers and is inexpensive to disseminate. Brief PRT training has been shown to significantly improve joint attention, expressive language, responsivity, and adaptive skills in young children with ASD. However, it is unknown whether an interactive, culturally competent online parent training in PRT is effective in a Latinx population. Objective: To this end, we will recruit 24 children (16-36 months old) at risk for ASD and their parent(s) from East and South Los Angeles and provide them with a series of 6 online learning modules in their choice of Spanish or English. Methods: This pilot study will utilize a single-group, pilot, pre-post design with follow-up assessments 6 weeks later. Linear mixed-effects model analysis will be used to explore most parent-reported and coded outcomes. Results: Brief online parent training in evidence-based treatments has the capacity to increase access to culturally competent early communication interventions for young children at risk for ASD. Conclusions: The results of this trial may have particular salience in additional underresourced communities where children have limited access to interventions prior to entering school. International Registered Report Identifier (IRRID): PRR1-10.2196/18004 ", doi="10.2196/18004", url="http://www.researchprotocols.org/2020/12/e18004/", url="http://www.ncbi.nlm.nih.gov/pubmed/33300494" } @Article{info:doi/10.2196/15149, author="St{\o}rksen, Therese Hege and Haga, Marie Silje and Slinning, Kari and Drozd, Filip", title="Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study", journal="JMIR Ment Health", year="2020", month="Nov", day="18", volume="7", number="11", pages="e15149", keywords="internet", keywords="parent support", keywords="children", keywords="mental health", keywords="acceptability", keywords="health care services", abstract="Background: Approximately 10\%-15\% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel's attitudes to perceived usefulness of internet-based interventions. Objective: The purpose of this study was to examine health professionals' perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. Methods: Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: ``How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?'' The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). Results: The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). Conclusions: Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support. ", doi="10.2196/15149", url="http://mental.jmir.org/2020/11/e15149/", url="http://www.ncbi.nlm.nih.gov/pubmed/33206058" } @Article{info:doi/10.2196/24536, author="Puzia, Megan and Laird, Breanne and Green, Jeni and Huberty, Jennifer", title="Parents' Perceptions of Their Children's Engagement in a Consumer-Based Meditation Mobile App: Cross-Sectional Survey Study", journal="JMIR Pediatr Parent", year="2020", month="Nov", day="13", volume="3", number="2", pages="e24536", keywords="mindfulness", keywords="meditation", keywords="children", keywords="mental health", keywords="sleep", keywords="mHealth", abstract="Background: In the United States, nearly half (48\%) of school-aged children experience sleep disturbance that results in less than the recommended sleep duration, which may negatively impact mental health and behavior. Mindfulness interventions may improve sleep and mental health in youth. However, there are gaps in the literature regarding how children (2-12 years) and adolescents (13-17 years) practice mindfulness and the extent to which they benefit from these practices. Objective: The purpose of this study was to determine parents' perceptions of their children's engagement with a consumer-based mindfulness meditation app and the extent to which they believe their children have benefitted from using the app, particularly with regard to sleep. Methods: This study is a secondary analysis of a cross-sectional survey in adult subscribers (N=11,108) to the mindfulness meditation mobile app Calm. Participants who indicated that they had a child or children younger than 18 years (2944/11,108) who used the Calm app were asked additional questions related to their perceptions of their children's engagement with Calm. Descriptive statistics were used to assess children's app engagement, and chi-square tests and binary logistic regression models were used to assess differences in children's usage based on gender and age. Results: Among the survey respondents, approximately half of the parents (1537/2944, 52.21\%) reported that their children used Calm. Children used Calm mostly for (1) sleep (1168/1537, 75.99\%), (2) stress (491/1537, 31.95\%), (3) depression or anxiety (430/1537, 27.98\%), and (4) improvement of overall health (215/1537,13.99\%). Older children were more likely to begin using Calm to reduce stress, depression, or anxiety, whereas younger children were more likely begin using Calm to improve sleep. Most children used Calm when lying down to go to bed (1113/1529, 72.79\%). Children were most likely to use sleep stories at night (1144/1207, 94.78\%), followed by music and soundscapes (749/1114, 67.24\%), meditations (736/1120, 65.71\%), and breathing exercises (610/1092, 55.86\%). Nearly all parents believed that using sleep stories was helpful for their children's sleep (1090/1128, 96.63\%), and the majority of parents felt that the other components were also helpful for their children's sleep (music and soundscapes [570/728, 78.30\%], meditations [445/696, 63.94\%], and breathing exercises [610/1092, 55.86\%]). Conclusions: To our knowledge, this is the first study to explore parents' perceptions of how their children or adolescents use a popular consumer-based mindfulness mobile app (ie, Calm). As the majority of children use the app for sleep, mindfulness meditation mobile apps should consider incorporating age-appropriate sleep content to meet the needs of this audience. More research is needed to confirm the feasibility and effectiveness of mindfulness meditation apps for improving sleep and mental health in children and adolescents. ", doi="10.2196/24536", url="http://pediatrics.jmir.org/2020/2/e24536/", url="http://www.ncbi.nlm.nih.gov/pubmed/33185564" } @Article{info:doi/10.2196/15786, author="Rabba, Stacey Aspasia and Dissanayake, Cheryl and Barbaro, Josephine", title="Development of a Web-Based Resource for Parents of Young Children Newly Diagnosed With Autism: Participatory Research Design", journal="JMIR Pediatr Parent", year="2020", month="Sep", day="30", volume="3", number="2", pages="e15786", keywords="autism", keywords="diagnosis", keywords="parents", keywords="support", keywords="co-design", keywords="eHealth", abstract="Background: The internet provides an ideal avenue to share information, advice, and support regarding autism. However, many websites lack quality control and rarely provide a one-stop resource for families to access necessary, evidence-based information. Objective: This study aims to use participatory action research (PAR) with end users (ie, parents) and clinicians to develop a web-based resource (Pathways Beyond Diagnosis) to improve timely access to quality, evidence-based information, and support for families after their child is diagnosed with autism. Methods: The PAR approach involves 4 phases: (1) cooperative researcher-stakeholder planning, (2) cooperative researcher-stakeholder--based action, (3) stakeholder observation, and (4) cooperative researcher-stakeholder reflection. A total of 15 participants (parents, n=3; clinicians, n=9; and researchers, n=3) attended individual or group participatory design workshops. This was followed by the translation of knowledge and ideas generated during the workshops to produce mockups of webpages and content, rapid prototyping, and one-on-one consultations with end users to assess the usability of the website developed. Results: A total of 3 participatory design workshops were held with the participants, each followed by a knowledge translation session. At the end of the PAR cycle, an alpha prototype of the website was built and a series of one-on-one end user consultation sessions were conducted. The PAR cycle revealed the importance of 6 key topic areas (understanding autism, accessing services, support, gaining funding, putting it all together, and looking into the future) associated with the time of diagnosis, which were incorporated into the beta version of the website. Conclusions: The development of the Pathways Beyond Diagnosis website using PAR ensures that families have ready access to practical and evidence-based information following a young child's diagnosis. The website guides families to access relevant, reputable, and evidence-based information in addition to summarizing key challenges encountered after diagnosis (ie, grief, sharing the diagnosis) and the importance of self-care. ", doi="10.2196/15786", url="http://pediatrics.jmir.org/2020/2/e15786/", url="http://www.ncbi.nlm.nih.gov/pubmed/32996890" } @Article{info:doi/10.2196/18271, author="Croucher, Lauren and Mertan, Elif and Shafran, Roz and Bennett, D. Sophie", title="The Use of Mumsnet by Parents of Young People With Mental Health Needs: Qualitative Investigation", journal="JMIR Ment Health", year="2020", month="Sep", day="3", volume="7", number="9", pages="e18271", keywords="mental health", keywords="parenting", keywords="internet", keywords="evidence-based medicine", abstract="Background: There are high rates of mental health needs in children in the United Kingdom, and parents are increasingly seeking help for their children's needs. However, there is not enough access to child and adolescent mental health services and parents are seeking alternative forms of support and information, often from web-based sources. Mumsnet is the largest web-based parenting forum in the United Kingdom, which includes user-created discussions regarding child mental health. Objective: This qualitative investigation aimed to explore the emergent themes within the narratives of posts regarding child mental health on Mumsnet and to extrapolate these themes to understand the purpose of Mumsnet for parents of children and young people with mental health needs. Methods: A total of 50 threads from Mumsnet Talk Child Mental Health were extracted. Following the application of inclusion and exclusion criteria, 41 threads were analyzed thematically using the framework approach, a form of qualitative thematic analysis. Results: In total, 28 themes were extracted and organized into 3 domains. These domains were emotional support, emotional expression, and advice and information. The results suggested that parents of children with mental health needs predominantly use Mumsnet to offer and receive emotional support and to suggest general advice, techniques, and resources that could be applied outside of help from professional services. Conclusions: This paper discusses the future of health information seeking. Future research is required to establish initiatives in which web-based peer-to-peer support and information can supplement professional services to provide optimum support for parents of children with mental health needs. ", doi="10.2196/18271", url="https://mental.jmir.org/2020/9/e18271", url="http://www.ncbi.nlm.nih.gov/pubmed/32880583" } @Article{info:doi/10.2196/13179, author="Jansen, Ronelle and Reid, Marianne", title="Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="19", volume="8", number="8", pages="e13179", keywords="caregiver", keywords="communication technology", keywords="adolescent", keywords="mental health issues", keywords="systematic review", keywords="self-efficacy, knowledge", keywords="parental skills", keywords="IMBP", abstract="Background: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective: The study aimed to answer the question: ``What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.'' Methods: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers' needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed. ", doi="10.2196/13179", url="http://mhealth.jmir.org/2020/8/e13179/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663143" } @Article{info:doi/10.2196/15664, author="Chu, Wai Joanna Ting and Wadham, Angela and Jiang, Yannan and Whittaker, Robyn and Stasiak, Karolina and Shepherd, Matthew and Bullen, Christopher", title="Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="20", volume="7", number="11", pages="e15664", keywords="programs", keywords="mHealth", keywords="adolescents", keywords="parents", keywords="text messaging", abstract="Background: Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen---an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective: The aim of this qualitative study was to explore parents and/or primary caregivers' perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods: A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results: Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions: Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents. ", doi="10.2196/15664", url="http://mhealth.jmir.org/2019/11/e15664/", url="http://www.ncbi.nlm.nih.gov/pubmed/31746767" } @Article{info:doi/10.2196/13628, author="Yap, Hui Marie Bee and Cardamone-Breen, C. Mairead and Rapee, M. Ronald and Lawrence, A. Katherine and Mackinnon, J. Andrew and Mahtani, Shireen and Jorm, F. Anthony", title="Medium-Term Effects of a Tailored Web-Based Parenting Intervention to Reduce Adolescent Risk of Depression and Anxiety: 12-Month Findings From a Randomized Controlled Trial", journal="J Med Internet Res", year="2019", month="Aug", day="15", volume="21", number="8", pages="e13628", keywords="family", keywords="parenting", keywords="mental health", keywords="depression", keywords="anxiety", keywords="adolescent", keywords="internet", keywords="randomized controlled trial", keywords="preventive health services", abstract="Background: Prevention of depression and anxiety disorders early in life is a global health priority. Evidence on risk and protective factors for youth internalizing disorders indicates that the family represents a strategic setting to target preventive efforts. Despite this evidence base, there is a lack of accessible, cost-effective preventive programs for parents of adolescents. To address this gap, we recently developed the Partners in Parenting (PiP) program---an individually tailored Web-based parenting program targeting evidence-based parenting risk and protective factors for adolescent depression and anxiety disorders. We previously reported the postintervention outcomes of a single-blinded parallel-group superiority randomized controlled trial (RCT) in which PiP was found to significantly improve self-reported parenting compared with an active-control condition (educational factsheets). Objective: This study aimed to evaluate the effects of the PiP program on parenting risk and protective factors and symptoms of adolescent depression and anxiety using data from the final assessment time point (12-month follow-up) of this RCT. Methods: Parents (n=359) and adolescents (n=332) were recruited primarily from secondary schools and completed Web-based assessments of parenting and adolescent depression and anxiety symptoms at baseline, postintervention (3 months later), and 12-month follow-up (317 parents, 287 adolescents). Parents in the PiP intervention condition received personalized feedback about their parenting and were recommended a series of up to 9 interactive modules. Control group parents received access to 5 educational factsheets about adolescent development and mental health. Both groups received a weekly 5-min phone call to encourage progress through their program. Results: Intervention group parents completed an average of 73.7\% of their intended program. For the primary outcome of parent-reported parenting, the intervention group showed significantly greater improvement from baseline to 12-month follow-up compared with controls, with a medium effect size (Cohen d=0.51; 95\% CI 0.30 to 0.72). When transformed data were used, greater reduction in parent-reported adolescent depressive symptoms was observed in the intervention group (Cohen d=?0.21; 95\% CI ?0.42 to ?0.01). Mediation analyses revealed that these effects were mediated by improvements in parenting (indirect effect b=?0.08; 95\% CI ?0.16 to ?0.01). No other significant intervention effects were found for adolescent-reported parenting or adolescent depression or anxiety symptoms. Both groups showed significant reductions in anxiety (both reporters) and depressive (parent reported) symptoms. Conclusions: PiP improved self-reported parenting for up to 9 months postintervention, but its effects on adolescent symptoms were less conclusive, and parent-reported changes were not perceived by adolescents. Nonetheless, given its scalability, PiP may be a useful low-cost, sustainable program to empower parents of adolescents. Trial Registration: Australian Clinical Trials Registration Number (ACTRN): 12615000328572; http://www.anzctr.org.au/ACTRN12615000328572.aspx (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj). ", doi="10.2196/13628", url="http://www.jmir.org/2019/8/e13628/", url="http://www.ncbi.nlm.nih.gov/pubmed/31418422" } @Article{info:doi/10.2196/jmir.9499, author="Cardamone-Breen, C. Mairead and Jorm, F. Anthony and Lawrence, A. Katherine and Rapee, M. Ronald and Mackinnon, J. Andrew and Yap, Hui Marie Bee", title="A Single-Session, Web-Based Parenting Intervention to Prevent Adolescent Depression and Anxiety Disorders: Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Apr", day="26", volume="20", number="4", pages="e148", keywords="adolescent", keywords="mental health", keywords="depression, anxiety, parenting", keywords="family", keywords="preventive health services", keywords="Internet", abstract="Background: Depression and anxiety disorders are significant contributors to burden of disease in young people, highlighting the need to focus preventive efforts early in life. Despite substantial evidence for the role of parents in the prevention of adolescent depression and anxiety disorders, there remains a need for translation of this evidence into preventive parenting interventions. To address this gap, we developed a single-session, Web-based, tailored psychoeducation intervention that aims to improve parenting practices known to influence the development of adolescent depression and anxiety disorders. Objective: The aim of this study was to evaluate the short-term effects of the intervention on parenting risk and protective factors and symptoms of depression and anxiety in adolescent participants. Methods: We conducted a single-blind, parallel group, superiority randomized controlled trial comparing the intervention with a 3-month waitlist control. The intervention is fully automated and consists of two components: (1) completion of an online self-assessment of current parenting practices against evidence-based parenting recommendations for the prevention of adolescent depression and anxiety disorders and (2) an individually tailored feedback report highlighting each parent's strengths and areas for improvement based on responses to the self-assessment. A community sample of 349 parents, together with 327 adolescents (aged 12-15 years), were randomized to either the intervention or waitlist control condition. Parents and adolescents completed online self-reported assessments of parenting and adolescent symptoms of depression and anxiety at baseline, 1-month (parent-report of parenting only), and 3-month follow-up. Results: Compared with controls, intervention group parents showed significantly greater improvement in parenting risk and protective factors from baseline to 1-month and 3-month follow-up (F2,331.22=16.36, P<.001), with a small to medium effect size at 3-month follow-up (d=0.33). There were no significant effects of the intervention on adolescent-report of parenting or symptoms of depression or anxiety in the adolescents (all P>.05). Conclusions: Findings suggest that a single-session, individually tailored, Web-based parenting intervention can improve parenting factors that are known to influence the development of depression and anxiety in adolescents. However, our results do not support the effectiveness of the intervention in improving adolescent depression or anxiety symptoms in the short-term. Long-term studies are required to adequately assess the relationship between improving parenting factors and adolescent depression and anxiety outcomes. Nonetheless, this is a promising avenue for the translation of research into a low-cost, sustainable, universal prevention approach. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12615000247572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000247572 (Archived by WebCite at http://www.webcitation.org/6v1ha19XG) ", doi="10.2196/jmir.9499", url="http://www.jmir.org/2018/4/e148/", url="http://www.ncbi.nlm.nih.gov/pubmed/29699964" } @Article{info:doi/10.2196/jmir.9139, author="Yap, Hui Marie Bee and Mahtani, Shireen and Rapee, M. Ronald and Nicolas, Claire and Lawrence, A. Katherine and Mackinnon, Andrew and Jorm, F. Anthony", title="A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Jan", day="19", volume="20", number="1", pages="e17", keywords="family", keywords="anxiety", keywords="parenting", keywords="depression", keywords="adolescent", keywords="Internet", keywords="mental health", keywords="preventive health services", abstract="Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents' risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent's strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children's Anxiety Scale (anxiety symptoms). Results: Parents in the intervention condition completed a mean of 73.7\% of their intended personalized PiP program. A total of 318 parents (88.6\%, 318/359) and 308 adolescents (92.8\%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95\% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents' risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents' mental health. Trial Registration: Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj) ", doi="10.2196/jmir.9139", url="http://www.jmir.org/2018/1/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/29351895" } @Article{info:doi/10.2196/mental.8492, author="Yap, BH Marie and Lawrence, A. Katherine and Rapee, M. Ronald and Cardamone-Breen, C. Mairead and Green, Jacqueline and Jorm, F. Anthony", title="Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety", journal="JMIR Ment Health", year="2017", month="Dec", day="19", volume="4", number="4", pages="e59", keywords="family", keywords="tailored", keywords="internet", keywords="mental health", keywords="preventive health services", doi="10.2196/mental.8492", url="http://mental.jmir.org/2017/4/e59/", url="http://www.ncbi.nlm.nih.gov/pubmed/29258974" } @Article{info:doi/10.2196/resprot.5319, author="Lange, Anne-Mette and Daley, David and Frydenberg, Morten and Rask, U. Charlotte and Sonuga-Barke, Edmund and Thomsen, H. Per", title="The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice", journal="JMIR Res Protoc", year="2016", month="Apr", day="13", volume="5", number="2", pages="e51", keywords="ADHD", keywords="preschool", keywords="child", keywords="treatment", keywords="parents", keywords="parent training", keywords="psycho-social", keywords="RCT, clinical", keywords="psychological", keywords="multi-centre", keywords="TAU", keywords="non-pharmacological", abstract="Background: Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective: The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1:1 basis, stratified for age and gender. Results: The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength \& Difficulties Questionnaire, direct observation of ADHD behaviors during Child's Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions: The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice. Trial Registration: ClinicalTrials.gov NCT01684644; https://clinicaltrials.gov/ct2/show/NCT01684644?term= NCT01684644\&rank=1 (Archived by WebCite at http://www.webcitation/6eOOAe8Qe) ", doi="10.2196/resprot.5319", url="http://www.researchprotocols.org/2016/2/e51/", url="http://www.ncbi.nlm.nih.gov/pubmed/27076496" }