Background Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood. Objective We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress. Methods After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. Results From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers). Conclusions Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress. Trial Registration Open Science Framework; osf.io/e52p3

Brain regions involved in reward processing undergo developmental changes from childhood to adolescence, and alterations in reward-related brain function are thought to contribute to the development of psychopathology. Event-related potentials (ERPs), such as the reward positivity (RewP) component, are valid measures of reward responsiveness that are easily assessed across development and provide insight into temporal dynamics of reward processing. Little work has systematically examined developmental changes in ERPs sensitive to reward. In this longitudinal study of 75 youth assessed 3 times across 6years, we used principal components analyses (PCA) to differentiate ERPs sensitive to monetary reward and loss feedback in late childhood, early adolescence, and middle adolescence. We then tested reliability of, and developmental changes in, ERPs. A greater number of ERP components differentiated reward and loss feedback in late childhood compared to adolescence, but components in childhood accounted for only a small proportion of variance. A component consistent with RewP was the only one to consistently emerge at each of the 3 assessments. RewP demonstrated acceptable reliability, particularly from early to middle adolescence, though reliability estimates varied depending on scoring approach and developmental period. The magnitude of the RewP component did not significantly change across time. Results provide insight into developmental changes in the structure of ERPs sensitive to reward, and indicate that RewP is a consistently observed and relatively stable measure of reward responsiveness, particularly across adolescence.

Background A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions—particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children—for instance, by mitigating known anxiety risk factors—remains unexplored. Objective This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring. Methods In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up. Results Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks. Conclusions Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets. Trial Registration ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9

No abstract

ERPs reveal the temporal dynamics of emotional processing and are easily assessed in children. Yet, little longitudinal research has examined ERPs sensitive to emotion across development. We aimed to systematically identify timing and spatial distributions of ERPs sensitive to emotion in a longitudinal sample of youth (N = 62) using principal component analysis (PCA) and evaluate stability and change in emotional responses across development. Participants completed an emotional interrupt paradigm in childhood (Mage = 9.38, SD = 0.42), early adolescence (Mage = 13.03, SD = 0.24), and midadolescence (Mage = 15.16, SD = 0.17). ERPs were recorded to unpleasant, pleasant, and neutral images. Participants were instructed to respond to a target while viewing images. Two components sensitive to emotion emerged across development: P300/early late positive potential (LPP) and late LPP. The P300/early LPP component was characterized by an enhanced positivity for unpleasant compared to pleasant and neutral images. The late LPP was enhanced for both unpleasant and pleasant compared to neutral images, and more positive for unpleasant compared to pleasant images. The components showed moderate to strong stability. Overall LPP magnitude decreased from childhood into adolescence. There was a developmental shift in distributions from occipital sites in childhood to centroparietal sites in midadolescence. Results support use of PCA to inform scoring windows and electrode selection. The shift in distribution may reflect developmental focalization in underlying neural circuitry. Future work is needed using multimodal approaches to further understand the relationship between ERPs and changes in neural circuitry across development.