Jeremy W. Pettit

Background: Family accommodation is a well‐established maintaining factor in childhood anxiety disorders and a target of evidence‐based interventions. Despite widespread clinical and research use of the Family Accommodation Scale—Anxiety (FASA), no empirically derived clinical cutoff score has been established. The present study aimed to determine a cutoff score on the parent‐rated FASA indicative of clinically meaningful accommodation of child anxiety. Methods: Participants were 1,185 youth (1,055 clinical; 130 community) aged 5–17 years, and their parents. Measures included the FASA, Screen for Child Anxiety Related Emotional Disorders (SCARED), and Anxiety Disorders Interview Schedule for Children and Parents (ADIS‐C/P). Receiver operating characteristic (ROC) analyses were conducted to establish cutoffs for the FASA against the established clinical threshold on the SCARED in the full sample (i.e. clinical and community), and against anxiety disorder diagnoses in the clinical sample. Benchmarking in the community sample provided an independent, norm‐referenced indicator of elevated accommodation. Results: ROC analyses identified an optimal cutoff of 11 (out of 36) on the FASA against the parent‐report SCARED criterion and a cutoff of 9 against a SCARED criterion met by either youth or parent. A criterion based only on the child‐report SCARED produced an area under the curve (AUC) below acceptable thresholds. Confirmatory analysis against ADIS‐C/P diagnostic data supported both SCARED‐based cutoffs (AUC = 0.76; sensitivity = 0.76 at cutoff of 9, 0.69 at cutoff of 11). Normative benchmarking placed a score of 9 at the 90th percentile of the community distribution. Conclusions: A FASA total score of 9 to 11 provides an empirically derived indicator of clinically significant family accommodation. A cutoff of 9 is recommended for screening and research contexts, while 11 may be more appropriate when higher specificity is desired.

Error monitoring allows for detecting mistakes and adapting behavior. Error monitoring is associated with increased theta (4-7 Hz) EEG activity recorded at midfrontal electrode sites located over the medial frontal cortex. Increases in theta synchrony after errors between midfrontal and lateral electrode sites, located over lateral prefrontal, motor, and sensory/parietal brain regions, are associated with post-error behavioral adaptations. However, there is a lack of research into whether such error-related theta inter-regional synchrony dynamics exhibit age-related changes across adolescence and whether such changes differ as a function of social observation. Moreover, there are discrepancies across studies in terms of how error-related theta synchrony between different electrode sites relates to specific forms of post-error adjustments. In this study, we used behavioral and EEG data from 262 adolescents aged 10-14 years who performed a flanker task twice: alone and while observed by a peer. Regardless of social observation, we found age-related increases in error-related midfrontal-frontolateral and midfrontal-midlateral theta synchrony. Additionally, we found that error-related theta synchrony between midfrontal and posterolateral regions increased only in the alone condition. Leveraging the shrinking spotlight drift diffusion model (SSP-DDM), we identified a positive association between error-related midfrontal-posterolateral theta synchrony and post-error attentional control but found no effects of social observation. These results are the first to demonstrate that error-related theta synchrony increases from early to mid-adolescence. Additionally, this work specifically links error-related midfrontal-posterolateral theta synchrony to post-error attentional control using computational modeling.

Smartphones and wearables are low–burden tools for assessing real–time mood and behavior. Although these methods have been used with adolescents for behavioral tracking (e.g., activity, sleep), less is known about longer–term use (beyond one week) with adolescents with depression and about mobile sensing for monitoring mood for any adolescent population. This study examined acceptability and feasibility of a one–month EMA, actigraphy, and mobile sensing protocol for adolescents with elevated depressive symptoms. Adolescents aged 12 to 18 ( N = 69; M age = 15.46; 67% assigned female at birth; 42% White; 71% Hispanic or Latine; 38% sexual minority) completed EMA surveys on depressive symptoms, processes, and affect multiple times daily via a smartphone app that also collected passive sensor data (e.g., motion, geolocation). An actigraph measured physical activity and sleep. A feedback interview assessed protocol acceptability. Most participants (91%) completed all components, were willing to participate again (91%), and would recommend participation to peers (93%). EMA response rates improved (mean completion 57% to 66%) after shifting to a semi–personalized schedule with extended response windows. Actigraph wear time was high (> 70%) despite device–related issues. Sensor data availability varied by operating system, and privacy concerns influenced participation. Adherence was correlated within and between modalities, suggesting that individual compliance played a central role in consistent engagement. Findings support the feasibility and acceptability of smartphone and wearable methods for capturing real–world mood and behavior in adolescents, however careful attention to design, engagement, and ethical considerations remains essential.

Error monitoring is the process by which the brain self-evaluates whether responses are correct and in line with achieving task goals. The error-related negativity (ERN), a neural marker of error monitoring, is influenced by the motivational significance of errors. For example, making a mistake while being observed can be more salient than when alone. The current narrative review assesses whether error monitoring is consistently upregulated within the presence of others. Additionally, we explore the possible influence of paradigm-related factors, such as deception and feedback, and individual factors, such as age and anxiety, on relations between social observation and the ERN. We find that use of deception or feedback may increase ERN amplitudes under social observation. In contrast, presence of an authority figure and whether an observer is physically (or virtually) present do not appear to impact effects of social observation. Specific subconstructs of anxiety, such as fear of negative evaluation, may more strongly influence the ERN under social observation. We also find that the ERN increases under social observation for both youth and adults, although potentially more consistently among youth. We conclude by providing methodological recommendations and propose future directions for this burgeoning area of research.

Despite theory and research linking parent anxiety to youth attention bias to threat, knowledge gaps remain regarding potential moderators. We examined youth attention focusing (i.e., ability to inhibit distractors and sustain attention) and attention shifting (i.e., ability to flexibility shift attention) as moderators of the association between parent anxiety and youth attention bias to threat among peripubertal youth with social anxiety disorder. We expected that parent anxiety would be associated with youth attention bias to threat at low levels of attention focusing and shifting. Participants were 165 clinically referred peripubertal youth (ages 9-14 years, M = 12.21 years; SD = 1.55; 73.9% White, 57.0% Hispanic or Latino; 63.0% females) with social anxiety disorder. We used a free-viewing task with eye tracking to measure youth attention bias to threat, self-ratings to measure youth attention focusing and shifting, and self-ratings to measure parent anxiety. Attention focusing, but not shifting, moderated the association between parent anxiety and youth attention bias to threat. At low levels of attention focusing, high parent anxiety was associated with high youth attention bias to threat. Findings suggest that parent anxiety serves as a signal that enhances socially anxious youths' attention to threat, particularly among those who struggle to sustain focused attention. We extend our findings to implications for theory and treatment of social anxiety in youth.

Introduction: Youth experiencing high levels of functional impairment may be at risk for suicidal ideation, but variables contributing to this risk remain unclear. The present study investigates the role of perceived burdensomeness toward others as an explanatory variable in the association between functional impairment and suicidal ideation in a sample of clinically referred youth, and whether this relationship differs by age. Methods: N = 383 clinically‐referred youth aged 6 to 17 ( M _age = 10.17, SD _age = 2.96; 81.8% Hispanic) completed measures of impairment, perceived burdensomeness, suicidal ideation, and depressive symptoms. Results: Functional impairment was significantly associated with perceived burdensomeness ( B = 0.39, p < 0.001), and perceived burdensomeness was significantly associated with suicidal ideation ( B = 0.02, p < 0.001). The indirect effect of impairment on suicidal ideation through perceived burdensomeness was statistically significant ( B = 0.005, SE = 0.002). The conditional indirect effect was significant and strengthened as a function of age. Conclusion: These findings provide novel evidence that perceived burdensomeness may explain the link between impairment and suicidal ideation in youth, and that this explanatory link strengthens with increasing age. Clinically, results underscore the need for developmentally tailored interventions that target perceptions of burdensomeness to mitigate suicidal thoughts in at‐risk youth.