Transdiagnostic clinical staging for childhood mental health: An adjunctive tool for classifying internalizing and externalizing syndromes that emerge in children aged 5-11 years

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

The Role of Executive Function in Children’s Mindfulness Experience

Objectives The effects of a 6-week mindfulness program were examined to assess how executive function level played a role in students’ mindful experience. The effects of the mindfulness program were evaluated according to prospective outcomes across students’ level of executive function, in comparison to an active control group. Methods Classrooms were randomly assigned to a mindfulness-based program or a health-based active control group. Pre- and early adolescent students in the 5th to 8th grade (N = 52) from two MindfulMe! program classrooms and two HealthyMe! program classrooms (active control group) completed self-reported pre-test and post-test measures to assess mindful attention awareness, strengths and difficulties, anxious arousal, rumination, and optimism. A composite score was created from student-, teacher-, and parent-reported BRIEF2 screening forms to determine students’ approximate level of executive function prior to the beginning of the program. Results There was a significant decrease in rumination for students in the mindfulness-based intervention when compared to the active controls. Findings suggest executive function predicted an individual’s change score in total difficulties, mindful attention awareness, optimism, and anxious arousal, after participating in a mindfulness-based intervention. Conclusions Mindfulness-based interventions appear to particularly benefit those with higher levels of executive function; however, an active control did not variably impact students according to their level of executive function.

Imaginal exposure for chronic worry : the role of anxious arousal and imaginal sensory information

This study examined the effect of exposure script references to anxious physiological sensations and the five senses upon anxious arousal during a single 30-minute imaginal exposure. Forty-five high worriers were randomized to two conditions: Comprehensive (all reference types included) or Limited (only visual and auditory references included). Anxious arousal was measured via heart rate (HR), skin conductance level (SCL) and self-report. Both conditions exhibited increased arousal patterns from baseline. SCL did not significantly decrease in either condition during exposure. For self-reported anxiety, Comprehensive participants exhibited significant decreases throughout exposure; but Limited participants demonstrated significant increases. Comprehensive participants reported significantly greater anticipated ability to cope after exposure. Results are discussed in the context of emotional processing theory.

Imaginal exposure for chronic worry : the role of anxious arousal and imaginal sensory information

This study examined the effect of exposure script references to anxious physiological sensations and the five senses upon anxious arousal during a single 30-minute imaginal exposure. Forty-five high worriers were randomized to two conditions: Comprehensive (all reference types included) or Limited (only visual and auditory references included). Anxious arousal was measured via heart rate (HR), skin conductance level (SCL) and self-report. Both conditions exhibited increased arousal patterns from baseline. SCL did not significantly decrease in either condition during exposure. For self-reported anxiety, Comprehensive participants exhibited significant decreases throughout exposure; but Limited participants demonstrated significant increases. Comprehensive participants reported significantly greater anticipated ability to cope after exposure. Results are discussed in the context of emotional processing theory.