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This study examined quality of life (QoL) in youth with misophonia compared to a general US youth sample and how misophonia-related variables (severity, number of triggers, responses), internalizing/externalizing symptoms, age and gender were associated with QoL among youth with misophonia. One-hundred and two children and adolescents (Mage = 13.7 [2.5]) with impairing misophonia symptoms completed self-report measures and clinical interviews. A comparison to a general US youth sample was conducted by dividing participants with misophonia into two age groups (< or ≥ 14 years). Older youth with misophonia reported poorer QoL than youth from the general US population, while no statistically significant difference emerged for younger youth with misophonia. More internalizing symptoms, more pessimism, a greater number of misophonia triggers, and being older were significantly associated with poorer QoL among youth with misophonia, with each variable explaining unique variance. Hence, youth with misophonia – particularly adolescents – may have lower QoL compared to their peers, and internalizing symptoms and pessimism are most strongly correlated with poorer QoL. Future research should examine what contributes to poor QoL among youth with misophonia and their family members and potential remedies. [ABSTRACT FROM AUTHOR]

A clear understanding of the item content of psychological assessments is critical but often overlooked. This study describes the content overlap of seven commonly used and psychometrically validated measures of anxiety among children and adolescents. Symptom codes were created for all items across measures and items were sorted by these codes, which all fell into specific symptom categories. We conducted two analyses of all items: a "bottom-up" content categorization approach, which used symptom categories that were developed during this study, and a "top-down" DSM-5 categorization which mapped items onto symptoms of anxiety disorders in the DSM-5. Findings reveal a weak mean overlap across the included measures of youth anxiety. This suggests that the scope of anxiety measures should be carefully considered when designing studies, interpreting research, or assessing youth in clinical practice. Further research is needed to develop and establish a coding scheme for a more objective, comprehensive content analysis. [ABSTRACT FROM AUTHOR]

Purpose: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children’s Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.There was a negative association between time in treatment and scores on the CSHQ-SF (b = − 3.23, SE = 0.493, t = − 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = − 4.66, SE = 0.405, t = − 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant.Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.Methods: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children’s Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.There was a negative association between time in treatment and scores on the CSHQ-SF (b = − 3.23, SE = 0.493, t = − 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = − 4.66, SE = 0.405, t = − 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant.Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.Results: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children’s Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.There was a negative association between time in treatment and scores on the CSHQ-SF (b = − 3.23, SE = 0.493, t = − 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = − 4.66, SE = 0.405, t = − 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant.Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.Conclusion: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children’s Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.There was a negative association between time in treatment and scores on the CSHQ-SF (b = − 3.23, SE = 0.493, t = − 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = − 4.66, SE = 0.405, t = − 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant.Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further. [ABSTRACT FROM AUTHOR]

• Evaluated two versions of parent-led CBT for anxiety in autistic youth. • Compared low with standard therapist contact. • No differences were found in primary or secondary outcomes. • 69% of completers were responders at posttreatment. • Low-contact CBT saved an average of $1,222.64 per family. Parent-led cognitive behavioral therapy (CBT) is an efficient, promising form of therapy that may be well suited for autistic youth with anxiety disorders, though to date it has been minimally tested. In this study, 87 autistic youth (7 to 13 years old) with anxiety disorders and their parents were randomized to two forms of parent-led CBT in which parents led their child through a guided CBT workbook across 12 weeks: one with low therapist contact (four 30-minute telehealth calls), and one with standard therapist contact (ten 60-minute telehealth calls). Anxiety, functional impairment, and autism features significantly declined across therapy, without differences between groups. High satisfaction was reported in both groups, though significantly higher satisfaction ratings were reported in standard-contact CBT. Responder rates were 69% of completers at posttreatment (70% in standard contact, 68% in low contact) and 86% at 3-month follow-up (86% in standard contact, 87% in low contact). Low-contact CBT was estimated to incur an average cost of $755.70 per family compared with $1,978.34 in standard-contact CBT. Parent-led CBT with minimal or standard therapist contact both appear to be effective CBT delivery formats for autistic youth with anxiety disorders, with significant cost savings for low-contact CBT. [ABSTRACT FROM AUTHOR]

Background: Hurricane Harvey struck southeast Texas in August 2017 resulting in widespread destruction and significant emotional distress. Objective: We examined the effectiveness of a transdiagnostic psychotherapeutic intervention delivered to youth with emotional disorders in a large, community health system following this hurricane. Methods: One hundred forty-nine youth aged 5 to 17 years with a history of hurricane exposure and emotional difficulties received an average of 6.4 (SD = 3.4) psychotherapy sessions using the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents. Youth-caregiver dyads completed measures of disaster exposure and impact at baseline as well as anxiety and depression at baseline and each therapy session. Symptom severity and level of functioning were rated by the clinician. Latent growth curve modeling was used to examine symptom change over time. Results: Children and adolescents began treatment with moderate levels of anxiety and depressive symptoms, symptom severity, and difficulties in daily functioning. Anxiety and depressive symptoms and symptom severity declined significantly over the treatment period. Clinician ratings of functionality evidenced significant improvement over time. Older age was correlated with more depressive symptoms at baseline and superior functioning at baseline with fewer completed treatment sessions. Conclusion: In this naturalistic, community-based effectiveness study we found significant improvement on measures of anxiety, depression, symptom severity, and daily functioning. Findings suggest that a transdiagnostic intervention may be effective for addressing a range of emotional concerns in the aftermath of a natural disaster. These results can be used to inform and refine evidence-based interventions that improve the mental health and wellbeing of disaster-exposed youth. [ABSTRACT FROM AUTHOR]

This study tested two versions of parent-led, Internet-delivered cognitive behavioral therapy for anxiety among autistic youth; one that provided weekly email support (iCBT-Email), and one that provided alternating bi-weekly emails and video calls (iCBT-Video) across 12 weeks. It was expected that those in the iCBT-Video condition would complete more treatment content, which in turn would lead to more anxiety improvement. Fifty-seven autistic youth (7-15 years-old) with anxiety disorders were randomized to iCBT-Email or iCBT-Video. There were no significant differences in improvement in clinician-rated, child-reported, or parent-reported anxiety severity or functional impairment. Posttreatment response rates were 55% in iCBT-Email and 67% in iCBT-Video. Module completion predicted improved treatment outcome, though there was no difference in module completion across groups. Therapists spent an average of 16.29 min/family/week (SD = 7.11) in the iCBT-Email condition and 24.13 min/family/week (SD = 6.84) in the iCBT-Video condition. Email and telehealth-supported, parent-led iCBT both appear to be effective treatments for autistic youth with anxiety disorders that require reduced therapist effort. Future research should seek novel methods to enhance engagement with iCBT content. NCT05284435. • RCT comparing two formats of parent-led iCBT for anxiety among autistic youth. • Minimal differences between telehealth and e-mail supported iCBT were found. • The majority of youth experienced clinically significant change. • Module completion significantly predicted improved treatment outcomes. [ABSTRACT FROM AUTHOR]

Higher level or acute psychiatric care for youth is intended to be active but short-term treatment focussing on crisis stabilisation, assessment, safety monitoring, and longer-term treatment planning. The focus of this article is on describing common challenges and the effort to address these challenges through new approaches to acute psychiatric care for children and adolescents. The review finds that (1) inpatient paediatric psychiatry beds are in high demand and often difficult to access, (2) there are a number of common challenges these units face including managing length of stays, readmissions, and adverse events, and (3) there are encouraging therapeutic approaches adapted for this setting. There is still much work to be done to advance the evidence-base for acute psychiatric care for youth particularly in defining and assessing an effective admission. Paediatric psychiatry patients are a vulnerable population and call for our best tools to be put to use to improve the quality and safety of care. [ABSTRACT FROM AUTHOR]

• Family accommodation has not been explored in youth with misophonia. • Accommodation was common and more frequent in anxious youth. • Family accommodation directly predicted misophonia severity. • Accommodation may be an important intervention target. Family accommodation (e.g., reassurance, modifying routines, assisting avoidance) has not been explored among youth with misophonia but may have important clinical and intervention implications. We examined family accommodation in 102 children and adolescents with interview-confirmed misophonia and compared its frequency and content to family accommodation in 95 children and adolescents with anxiety disorders. Findings showed that family accommodation was ubiquitous in pediatric misophonia and may be even more frequent than in youth with anxiety disorders. Assisting the child, participating in misophonia-related behaviors, and modifying family routines were endorsed by more than 70% of parents of children with misophonia. Further, compared to parents of children with anxiety disorders, parents of children with misophonia more frequently reported child distress and anger when they did not accommodate. Family accommodation was moderately to strongly associated with misophonia severity even when accounting for co-occurring internalizing and externalizing symptoms and sociodemographic factors. This first study of family accommodation in pediatric misophonia suggests accommodation may be an important clinical feature. A notable study limitation is that the measure of misophonia did not delineate between adaptive versus maladaptive accommodations. Excessive and maladaptive accommodation may be one potential candidate to target in interventions when considered within a broader treatment plan. Importantly, adaptive accommodations should also be considered in day-to-day management if they improve functioning and quality of life. [ABSTRACT FROM AUTHOR]

Objective: To examine the efficacy of pharmacological treatments for restricted and repetitive behaviors (RRB) in autism spectrum disorders (ASD).Method: We searched PubMed, Embase, and CENTRAL to identify all double-blind, randomized, placebo-controlled trials that examined the efficacy of pharmacological agents in the treatment of ASD and measured RRB as an outcome. Our primary outcome was the standardized mean difference in rating scales of RRB.Results: We identified 64 randomized, placebo-controlled trials involving 3,499 participants with ASD. Antipsychotics significantly improved RRB outcomes compared to placebo (standardized mean difference [SMD] = 0.28, 95% CIs = 0.08-0.49), z = 2.77, p = .01) demonstrating a small effect size. Larger significant positive effects on RRB in ASD were seen in individual studies with fluvoxamine, buspirone, bumetanide, divalproex, guanfacine, and folinic acid that have not been replicated. Other frequently studied pharmacological treatments in ASD including oxytocin, omega-3 fatty acids, selective serotonin reuptake inhibitors (SSRI), and methylphenidate did not demonstrate significant benefit in reducing RRB compared to placebo (oxytocin: SMD = 0.23, 95% CI = -0.01 to 0.47, z = 1.85, p = .06; omega-3 fatty acids: SMD = 0.19, 95% CI = -0.05 to 0.43, z = 1.54, p = .12; SSRI: SMD = 0.09, 95% CI = -0.21 to 0.39, z = 0.60, p = .56; methylphenidate: SMD = 0.18, 95% CI = -0.11 to 0.46, z = 1.23, p = .22).Conclusion: The results of the present meta-analysis suggest that currently available pharmacological agents have at best only a modest benefit for the treatment of RRB in ASD, with the most evidence supporting antipsychotic medications. Additional randomized controlled trials with standardized study designs and consistent and specific assessment tools for RRB are needed to further understand how we can best help ameliorate these behaviors in individuals with ASD. [ABSTRACT FROM AUTHOR]

To examine the efficacy of the parent-led intervention Supportive Parenting for Anxious Childhood Emotions (SPACE) relative to a low-dose version of the protocol among children and adolescents with clinically significant anxiety and/or obsessive-compulsive disorder (OCD). Method: 68 youth (7-17) with anxiety/OCD and their parents were randomized to receive 12 weekly telehealth SPACE sessions (SPACE-Standard) or bibliotherapy plus 4 telehealth sessions over 12 weeks (SPACE-light). After screening, assessments were conducted via videoconferencing at baseline, post-treatment, and one-month follow-up. Independent evaluators were blind to treatment condition. Treatment condition did not predict whether a participant responded to the intervention (SPACE-Standard = 70%; SPACE-Light = 68%), nor was treatment condition a predictor of anxiety severity, parent-reported anxiety, or parent-/child-reported functional impairment at post-treatment or one-month follow-up. Youth in SPACE-Light self-reported higher post-treatment anxiety than youth in SPACE-standard, though this was no longer significant at one-month follow-up. Parent-reported family accommodation total change scores were associated with anxiety severity at post-treatment across both arms. This is the second randomized controlled trial (RCT) evaluating SPACE and provides further support for the efficacy of this intervention both in standard and low-dose formats. This study provides support for parent-led anxiety treatment targeting family accommodation as a primary mechanism of change and extends evidence of efficacy to a more clinically diverse sample. ClinicalTrials.gov Registry: NCT04922502. https://classic.clinicaltrials.gov/ct2/show/NCT04922502. • Examined the efficacy of Supportive Parenting for Anxious Childhood Emotions (SPACE) versus a low-dose version. • This is the second RCT evaluating SPACE. • Response rates were not different between SPACE-Standard (70%) versus SPACE-Light (68%). • Change in family accommodation was associated with anxiety severity at post-treatment. • This study provides support for parent-led anxiety treatment targeting family accommodation as a primary mechanism of change. [ABSTRACT FROM AUTHOR]

Mesenchymal stem cells (MSCs) could be a promising solution in the treatment of various diseases including chronic kidney disease (CKD). However, endoplasmic reticulum (ER) stress induced by ischemia in the area of application limits the integration and survival of MSCs in patients. In our study, we generated ER stress-induced conditions in MSCs using P-cresol. As P-cresol is a toxic compound accumulated in the body of CKD patients and induces apoptosis and inflammation through reactive oxygen species (ROS), we observed ER stress-induced MSC apoptosis activated by oxidative stress, which in turn resulted from ROS generation. To overcome stress-induced apoptosis, we investigated the protective effects of tauroursodeoxycholic acid (TUDCA), a bile acid, on ER stress in MSCs. In ER stress, TUDCA treatment of MSCs reduced ER stress-associated protein activation, including GRP78, PERK, eIF2α, ATF4, IRE1α, and CHOP. Next, to explore the protective mechanism adopted by TUDCA, TUDCA-mediated cellular prion protein (PrPC) activation was assessed. We confirmed that PrPC expression significantly increased ROS, which was eliminated by superoxide dismutase and catalase in MSCs. These findings suggest that TUDCA protects from inflammation and apoptosis in ER stress via PrPC expression. Our study demonstrates that TUDCA protects MSCs against inflammation and apoptosis in ER stress by PrPC expression in response to P-cresol exposure. [ABSTRACT FROM AUTHOR]

Analysis of human pathology led Braak to postulate that α-synuclein (α-syn) pathology could spread from the gut to brain via the vagus nerve. Here, we test this postulate by assessing α-synucleinopathy in the brain in a novel gut-to-brain α-syn transmission mouse model, where pathological α-syn preformed fibrils were injected into the duodenal and pyloric muscularis layer. Spread of pathologic α-syn in brain, as assessed by phosphorylation of serine 129 of α-syn, was observed first in the dorsal motor nucleus, then in caudal portions of the hindbrain, including the locus coeruleus, and much later in basolateral amygdala, dorsal raphe nucleus, and the substantia nigra pars compacta. Moreover, loss of dopaminergic neurons and motor and non-motor symptoms were observed in a similar temporal manner. Truncal vagotomy and α-syn deficiency prevented the gut-to-brain spread of α-synucleinopathy and associated neurodegeneration and behavioral deficits. This study supports the Braak hypothesis in the etiology of idiopathic Parkinson's disease (PD). • Gut-to-brain propagation of pathologic α-synuclein via the vagus nerve causes PD • Dopamine neurons degenerate in the pathologic α-synuclein gut-to-brain model of PD • Gut injection of pathologic α-synuclein causes PD-like motor and non-motor symptoms • PD-like pathology and symptoms require endogenous α-synuclein Gut injection of α-synuclein fibrils converts endogenous α-synuclein to a pathologic species that spreads to the brain. This leads to features of Parkinson's disease, and vagotomy and α-synuclein deficiency prevent the neuropathology and neurobehavioral deficits induced by transmitted pathological α-synuclein. [ABSTRACT FROM AUTHOR]