Daniel P. Dickstein

Introduction: Anxiety disorders are the most common youth mental health problems in the USA. Most children do not receive treatment and among the few who do, many do not experience significant improvement. Thus, there is an urgent need to identify novel intervention targets to improve treatments for childhood anxiety. Past research demonstrates that parent anxiety plays a role in the development and maintenance of child anxiety, but empirical evidence for the mechanisms that drive this transmission is lacking. Interpretation bias, or the tendency to perceive threat in ambiguous situations, may lead parents to engage in anxiety-promoting parenting behaviours, which may transfer this cognitive bias to their children, resulting in youth anxiety. Given the current lack of empirical evidence supporting this theorised mechanism, the present study will test effects of parent interpretation bias on parent behaviour and child interpretation bias. Our central hypothesis is that parent interpretation bias influences child interpretation bias through its effects on anxiety-promoting parenting behaviours. The study will also evaluate potential moderators of these theorised relationships, such as parent sex, race and ethnicity, parent anxiety, child age and child sex. Methods and analysis: We will randomise 300 parents of children aged 7–12 to a smartphone app-delivered interpretation bias manipulation condition or a self-assessment control condition. Through a series of study assessments over the course of 3 months, parents and children will complete self-report, interview, behavioural and daily diary measures to assess the primary proximal outcome (anxiety-promoting parenting behaviours), the secondary distal outcome (child interpretation bias) and moderators. To test our central hypothesis, we will first use hierarchical linear modelling to assess whether parents in the interpretation bias manipulation condition show fewer anxiety-promoting parenting behaviours compared with control, and whether children of those parents show improved interpretation bias compared with control. We will then implement mediation models to evaluate whether a reduction in anxiety-promoting parenting behaviours mediates the association between parent and child interpretation bias. Ethics and dissemination: Ethical approval for this study was granted by the Mass General Brigham Institutional Review Board (2022P003245). We will disseminate the results of this study to the scientific community, clinical community and the public through several channels such as peer-reviewed publications in scientific journals, national conferences, hospital lectures, press releases and Psychology Today blog posts. Trial registration number: NCT05665491 .

Autistic children often consume less varied diets, experience sleep difficulties, and have higher rates of mental health problems as compared to neurotypical peers. Yet, the direct relationship between all of these domains is not well characterized. We leveraged the Adolescent Brain Cognitive Development ^SM study (ABCD study) dataset to explore whether estimated levels of consumption of specific macro‐ and micronutrients correlated with the severity of mental health and sleep problems in autistic youth. We found that low vitamin B3, B6, C, and iron intake was associated with more severe psychiatric problems in autistic children in the ABCD cohort, though these findings did not reach statistical significance after correction for multiple comparisons. In a post hoc analysis, we found that the severity of sleep difficulties was correlated with estimated levels of Vitamins B3, B6, C, and iron intake and with the severity of anxiety/depressive symptoms and/or thought problems. Our analysis on a large number of nutrients, psychiatric symptoms, and sleep serves as an exploratory, initial analysis to identify specific nutrients and psychiatric symptoms that could be the focus of future (confirmatory) studies on the relationship between nutrition, sleep, and mental health in autistic individuals.

Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD. Methods: We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis. Results: The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations. Conclusions: In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care.