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There are strong arguments for standardizing therapies for mental health difficulties in young people and for the development of digital therapies. At the same time, the importance of personalized treatments is also increasingly apparent. In this editorial, we discuss challenges and the continued need to find the sweet spot between standardization and personalization when it comes to therapies for mental health difficulties. We illustrate our discussion with reference to insomnia in adolescents/young adults as well as the chronic health condition type 1 diabetes.

BackgroundLittle is known about the prevalence and natural trajectory of post-COVID symptoms in young people, despite very high numbers of young people having acute COVID. To date, there has been no prospective follow-up to establish the pattern of symptoms over a 6-month time period.MethodsA non-hospitalised, national sample of 3,395 (1,737 SARS-COV-2 Negative;1,658 SARS-COV-2 Positive at baseline) children and young people (CYP) aged 11-17 completed questionnaires 3 and 6 months after PCR-confirmed SARS-CoV-2 infection between January and March 2021 and were compared with age, sex and geographically-matched test-negative CYP.ResultsThree months after a positive SARS-CoV-2 PCR test, 11 of the 21 most common symptoms reported by >10% of CYP had reduced. There was a further decline at 6 months. By 3 and 6 months the prevalence of chills, fever, myalgia, cough and sore throat of CYP who tested positive for SARS-CoV-2 reduced from 10-25% at testing to ConclusionsIn CYP, the prevalence of specific symptoms reported at time of PCR-testing declined with time. Similar patterns were observed among test-positives and test-negatives and new symptoms were reported six months post-test for both groups suggesting that symptoms are unlikely to exclusively be a specific consequence of SARS-COV-2 infection. Many CYP experienced unwanted symptoms that warrant investigation and potential intervention.

BACKGROUND: Little is known about the prevalence and natural trajectory of post-COVID symptoms in young people, despite very high numbers of young people having acute COVID. To date, there has been no prospective follow-up to establish the pattern of symptoms over a 6-month time period. METHODS: A non-hospitalised, national sample of 3,395 (1,737 SARS-COV-2 Negative;1,658 SARS-COV-2 Positive at baseline) children and young people (CYP) aged 11-17 completed questionnaires 3 and 6 months after PCR-confirmed SARS-CoV-2 infection between January and March 2021 and were compared with age, sex and geographically-matched test-negative CYP. RESULTS: Three months after a positive SARS-CoV-2 PCR test, 11 of the 21 most common symptoms reported by >10% of CYP had reduced. There was a further decline at 6 months. By 3 and 6 months the prevalence of chills, fever, myalgia, cough and sore throat of CYP who tested positive for SARS-CoV-2 reduced from 10-25% at testing to

Supplemental Material for The Influence of Comorbidity and Perceived Complexity on Outcomes of Referrals to Children and Young Person Mental Health Services (UK): A Mixed Methods Vignette Study by Georgia R. Byrne, Roz Shafran, Katy Whadcock and Sophie D. Bennett in Clinical Child Psychology and Psychiatry

Objectives: To explore the impact of various measurements of long-term health conditions (LTCs) on the resulting prevalence estimates using data from a nationally representative dataset. Methods: Children and young people (CYP) in the Millennium Cohort Study (MCS) were followed at ages 3, 5, 7, 11, and 14 years (N = 15,631). We estimated the weighted prevalence of LTCs at each time point and examined the degree to which estimates agreed with alternate health indicators (special educational needs and disability [SEND], specific chronic conditions, and common chronicity criteria) using descriptive analyses, Cohen’s kappa statistic, and percentage agreement. Results: The estimated weighted prevalence of LTCs peaked at 5 years old (20%). Despite high percentage agreement, we observed at best moderate chance-corrected agreement between the type of LTC and reasons for SEND (kappas from 0.02 to 0.56, percentage agreement from 97% to 99%) or specified chronic conditions (kappas from 0.002 to 0.02, percentage agreement from 73% to 97%). Applying chronicity criteria decreased the estimated weighted prevalence of LTCs (3%). Conclusion: How long-term conditions are defined drastically alters the estimated weighted prevalence of LTCs. Improved clarity and consistency in the definition and measurement of LTCs is urgently needed to underpin policy and commissioning of services.

A multitude of studies point towards the relevance of perfectionism in both the etiology and maintenance of various psychological disorders. Based on these observations, perfectionism has been proposed as a transdiagnostic process, that is to say, a process which exists across various disorders. Crucially, a transdiagnostic process must fulfil the criterion of causality by not only correlating with, but contributing to the etiology and maintenance of psychological disorders (Harvey et al., 2004). Transdiagnostic approaches aim to understand core processes underlying multiple psychopathologies and have gained increasing attention (Barlow et al., 2016; Ehring et al., 2008; Kring et al., 2010). They enable the development of models and treatments for processes instead of single disorders. Perfectionism has been found to be associated with different types of symptoms, including those indicative of Obsessive-Compulsive Disorder (OCD) and eating disorders (Egan et al., 2011; Limburg et al., 2017). The two conditions are frequently comorbid and assumed to share etiological relationships (Altman et al., 2009). However, the causality between perfectionism and these disorders is relatively understudied, as previous investigations have been conducted predominantly via cross-sectional studies. In order to approach an understanding of causality, temporal relations must be investigated. To this end, a longitudinal study design would be ideally suited. Additionally, previous research has tended to focus on one type of psychopathology, whereas simultaneous investigation of several different disorders is as of yet still lacking. So far, it is unclear (a) in which ways perfectionism increases a general risk for psychopathology, and (b) how perfectionism can lead to different specific disorders (e.g., OCD in one person and bulimia in another). To address these important questions, Nolen-Hoeksema and Watkins (2011) have suggested a heuristic for developing transdiagnostic models of psychopathology. Their heuristic proposes that transdiagnostic risk factors operate at different levels relative to the resulting psychopathology they cause. Within this model, so-called proximal risk factors such as perfectionism can lead to multiple types of disorders (multifinality). These proximal risk factors interact with moderating variables which can occur at the same time or after the proximal risk factor. Whether a specific type of symptomatology develops in the presence of this proximal risk factor (divergent trajectories) is assumed to depend on the presence of disorder-specific moderating variables. In the case of eating disorder and OCD symptoms, variables that have been suggested as possible moderators between perfectionism and symptomatology are body dissatisfaction (Boone et al., 2014, 2015) and inflated responsibility (Salkovskis et al., 2000), respectively. Thus, it is the aim of the current study to investigate the potential of perfectionism as a transdiagnostic risk factor. A longitudinal design will be employed to investigate the temporal relations between perfectionism and symptoms of more than one disorder at a time (multifinality), namely eating disorders and OCD. Additionally, the study will examine body dissatisfaction and responsibility as possible disorder-specific moderators between perfectionism and symptoms of eating disorders or OCD (divergent trajectories).

Additional file 1: Appendix A. Patient Characteristics from the OutcomeStudy. Appendix B. Base-case Model ICER Scatter Plot. Appendix C. Practical Model ICER Scatter Plot.

Supplemental Material, sj-pdf-1-ccp-10.1177_13591045221105193 for Growth mindset in young people awaiting treatment in a paediatric mental health service: A mixed methods pilot of a digital single-session intervention by Brian CF Ching, Sophie D Bennett, Nicola Morant, Isobel Heyman, Jessica L Schleider, Kate Fifield, Sophie Allen and Roz Shafran in Polymers and Polymer Composites

INTRODUCTION: There is uncertainty surrounding the diagnosis, prevalence, phenotype, duration and treatment of Long COVID. This study aims to (A) describe the clinical phenotype of post-COVID symptomatology in children and young people (CYP) with laboratory-confirmed SARS-CoV-2 infection compared with test-negative controls, (B) produce an operational definition of Long COVID in CYP, and (C) establish its prevalence in CYP. METHODS AND ANALYSIS: A cohort study of SARS-CoV-2-positive CYP aged 11-17 years compared with age, sex and geographically matched SARS-CoV-2 test-negative CYP. CYP aged 11-17 testing positive and negative for SARS-CoV-2 infection will be identified and contacted 3, 6, 12 and 24 months after the test date. Consenting CYP will complete an online questionnaire. We initially planned to recruit 3000 test positives and 3000 test negatives but have since extended our target. Data visualisation techniques will be used to examine trajectories over time for symptoms and variables measured repeatedly, separately by original test status. Summary measures of fatigue and mental health dimensions will be generated using dimension reduction methods such as latent variables/latent class/principal component analysis methods. Cross-tabulation of collected and derived variables against test status and discriminant analysis will help operationalise preliminary definitions of Long COVID. ETHICS AND DISSEMINATION: Research Ethics Committee approval granted. Data will be stored in secure Public Health England servers or University College London's Data Safe Haven. Risks of harm will be minimised by providing information on where to seek support. Results will be published on a preprint server followed by journal publication, with reuse of articles under a CC BY licence. Data will be published with protection against identification when there are small frequencies involved. TRIAL REGISTRATION NUMBER: ISRCTN34804192; Pre-results.

Background: Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. Methods: In total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. Discussion: This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. Trial registration: ISRCTN ISRCTN57823197. Registered on 25 February 2019.

Supplemental Material, sj-docx-1-ccp-10.1177_13591045211033186 for A survey of mental health professionals in a paediatric hospital during COVID-19 by Brian CF Ching, Sophie D Bennett, Isobel Heyman, Holan Liang, Matteo Catanzano, Kate Fifield, Zoe Berger, Suzanne Gray, Emma Hewson, Mandy Bryon, Anna E Coughtrey and Roz Shafran in Clinical Child Psychology and Psychiatry

Supplemental Material, sj-pdf-1-ccp-10.1177_13591045211028539 for An investigation into the psychosocial impact of therapeutic recreation summer camp for youth with serious illness and disability by Jacquelyn Yang, Roz Shafran, Sophie Bennett and Allan Jolly in Clinical Child Psychology and Psychiatry

In 1995 the Obsessive Compulsive Cognitions Working Group initiated a collective process to develop two measures of cognition relevant to current cognitive-behavioural models of OCD. An earlier report (Behav. Res. Therapy, 35 (1997) 667) describes the original process of defining relevant domains. This article describes the subsequent steps of the development and validation process: item generation, scale reduction, and initial examination of reliability and validity. Two scales were developed. The Obsessive Beliefs Questionnaire consists of 87 items representing dysfunctional assumptions covering six domains: overestimation of threat, tolerance of uncertainty, importance of thoughts, control of thoughts, responsibility, and perfectionism. The Interpretation of Intrusions Inventory consists of 31 items that refer to interpretations of intrusions that have occurred recently. Three of the above domains are represented: importance of thoughts, control of thoughts, and responsibility. The item reduction and validation analyses were conducted on clinical and non-clinical samples from multiple sites. Initial examination of reliability and validity indicates excellent internal consistency and stability and encouraging evidence of validity. However, high correlations indicating overlap between some of the scales, particularly importance of thoughts, control of thoughts, and responsibility will need to be addressed in subsequent empirical and theoretical investigations.