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Background: Prevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children's functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems., Methods: Baseline data were collected from a national randomized controlled intervention study. Children aged 8-12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population's mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach's alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman's correlations. Construct validity was assessed via confirmatory factor analysis., Results: Internal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach's alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T., Conclusions: Internal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children. Trial registration in Clinical Trials: NCT02340637; June 12, 2014., (© 2021. The Author(s).)

Background: Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8-12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS., Methods: Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children., Discussion: This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement.

Background: Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains., Methods: The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables., Results: Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression., Conclusions: Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

Background: Symptoms of anxiety and depression are common mental health problems in children and are often referred to as internalizing symptoms. Youth with such symptoms are at greater risk for poor academic achievement, school non-completion, and future mental health problems, all of which, lead to public health consequences and costs to society. The aim of the current study was to investigate associations between young school children's internalizing symptoms and school functioning, as assessed separately by the teachers and the children., Methods: This study is a cross-sectional study including children (N = 750. 58% girls) from the ages of 8-12 years with elevated levels of self-reported symptoms of anxiety (MASC-C) and/or depression (SMFQ). Teachers reported the academic achievement, school adaptation (TRF) and internalizing symptoms (BPM-T) of the children. Associations were analyzed using linear regression analyses., Results: Both teacher-reported internalizing symptoms and children's self-reported depressive symptoms were associated with poor academic achievement and school adaptation, while self-reported symptoms of anxiety were not. Symptoms of depression as assessed by the children were associated with teacher-rated internalizing symptoms, while self-reported symptoms of anxiety were not., Conclusion: We found negative associations between school functioning and internalizing symptoms, as assessed by both the teachers and the children. The dual findings strengthen the validity of these relationships. Thus, prevention of depressive and anxiety symptoms in children may lead to positive changes in school domains such as academic achievement and school adaptation. We also identified a negative association between teacher-rated internalizing symptoms and children's self-report of depressive symptoms, indicating that teachers may have difficulties recognizing children with these symptoms., Trial Registration: Clinical Trials NCT02340637, Registered on June 12, 2014, Retrospectively registered.

Background: Symptoms of anxiety and depression are prevalent and highly comorbid in children, contributing to considerable impairment even at a subclinical level. Difficulties with emotion regulation are potentially related to both anxious and depressive symptoms. Research looking at maternal contributions to children's mental health dominates the literature but ignores the potentially important contributions of fathers., Method: The present study is part of the Coping Kids study in Norway, a randomized controlled study of a new indicated preventive intervention for children, EMOTION. EMOTION aims to reduce levels of anxious and depressive symptoms in children aged 8-12 years. Using cross sectional data and multiple regression analyses, we investigated the relations between anxious and depressive symptoms and emotion regulation in n = 602 children. Symptoms were reported by the child, mothers and fathers. Emotion regulation was reported by mothers and fathers., Results: Symptoms of anxiety, as reported by parents, were associated with poorer emotion regulation. This association was also demonstrated for depressive symptoms as reported by both parents and children. When analyzing same gender reports, parental gender did not differentiate the relationship between anxiety symptoms and emotion regulation. For depressive symptoms, we did find a differentiating effect of parental gender, as the association with dysregulation of emotion was stronger in paternal reports, and the association with adaptive emotion regulation was stronger in maternal reports. When using reports from the opposite parent, the emotion regulation difficulties were still associated with depressive and anxiety symptoms, however exhibiting somewhat different emotional regulation profiles., Conclusion: Problems with emotion regulation probably coexists with elevated levels of internalizing symptoms in children. In future research, both caregivers should be included., Trial Registration: The regional ethics committee (REC) of Norway approved the study. Registration number: 2013/1909; Project title: Coping Kids: a randomized controlled study of a new indicated preventive intervention for children with symptoms of anxiety and depression. ClinicalTrials.gov; Protocol ID 228846/H10 .

Background: High levels of anxiety and depression are common psychological symptoms among children and adolescents. These symptoms affect young people in multiple life domains and are possible precursors of long-term psychological distress. Despite relatively high prevalence, few children with emotional problems are referred for clinical treatment, indicating the need for systematic prevention. The primary aim of this study is to evaluate an indicated preventive intervention, EMOTION Coping Kids Managing Anxiety and Depression (EMOTION), to reduce high levels of anxiety and depressive symptoms., Methods/design: This is a clustered randomized controlled trial involving 36 schools, which are assigned to one of two conditions: (a) group cognitive behavioral intervention EMOTION or (b) treatment as usual (TAU). Assessments will be undertaken at pre-, mid - intervention, post-, and one year after intervention. The children (8-11 years old) complete self-report questionnaires. Parents and teachers report on children. The primary outcome will be changes in depressive and anxiety symptoms as measured by the Short Mood and Feelings Questionnaire (SMFQ) and Multidimensional Anxiety Scale for Children (MASC) respectively. Secondary outcomes will be changes in self-esteem, quality of life, and school and daily functioning. Observers will assess implementation quality with ratings of fidelity based on video recordings of group leaders leading the EMOTION group sessions., Discussion: The present study is an important contribution to the field regarding working with children with symptoms of anxiety and depression. The results of this study will provide an indication whether or not the EMOTION program is an effective intervention for the prevention of later depression and/or anxiety in children. The study will also provide information about the EMOTION program's effect on quality of life, self-esteem, and school functioning of the children participating in the study. Finally, the project will provide insight into implementation of an indicated intervention for school-aged children within Norwegian health, education, and mental health services., Trial Registration: Clinical Trials NCT02340637 , Registered on June 12, 2014, last updated on January 15, 2015. Retrospectively registered.

Background: Anxiety and depressive symptoms are common in childhood, however problems in need of intervention may not be identified. Children at risk for developing more severe problems can be identified based on elevated symptom levels. Quality of life and self-esteem are important functional domains and may provide additional valuable information., Methods: Schoolchildren (n = 915), aged 9-13, who considered themselves to be more anxious or sad than their peers, completed self-reports of anxiety (Multidimensional Anxiety Scale for children (MASC-C), depression (The Short Mood and Feelings Questionnaire; SMFQ), quality of life (Kinder Lebensqualität Fragebogen; KINDL) and self-esteem (Beck self-concept inventory for youth (BSCI-Y) at baseline of a randomized controlled indicative study. Using multivariate analyses, we examined the relationships between internalizing symptoms, quality of life and self-esteem in three at-risk symptom groups. We also examined gender and age differences., Results: 52.1 % of the screened children scored above the defined at-risk level reporting elevated symptoms of either Anxiety and Depression (Combined group) (26.6 %), Depression only (15.4 %) or Anxiety only (10.2 %). One-way ANOVA analysis showed significant mean differences between the symptom groups on self-reported quality of life and self-esteem. Regression analysis predicting quality of life and self-esteem showed that in the Depression only group and the Combined group, symptom levels were significantly associated with lower self-reported scores on both functional domains. In the Combined group, older children reported lower quality of life and self-esteem than younger children. Internalizing symptoms explained more of the variance in quality of life than in self-esteem. Symptoms of depression explained more of the variance than anxious symptoms. Female gender was associated with higher levels of internalizing symptoms, but there was no gender difference in quality of life and self-esteem., Conclusion: Internalizing symptoms were associated with lower self-reported quality of life and self-esteem in children in the at-risk groups reporting depressive or depressive and anxious symptoms. A transdiagnostic approach targeting children with internalizing symptoms may be important as an early intervention to change a possible negative trajectory. Tailoring the strategies to the specific symptom pattern of the child will be important to improve self-esteem., Trial Registration: Trial registration in Clinical trials: NCT02340637 , June 12, 2014.