Tag: Anxiety

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Boys, Masculinity, and the Looksmaxxing Trend  

By now, you’ve probably heard of the term looksmaxxing. Think pieces about the trend have popped up all over the internet. And in a recent episode of Saturday Night Live, comedians poked fun at lookmaxxing influencers obsessed with having the perfect male physique.

While this new social media craze may seem silly, it’s impacting more boys than you might think. In a study conducted last year that surveyed over 3,000 young men (ages 16–25) from the United States, United Kingdom, and Australia, nearly two-thirds of participants were regularly engaging with masculinity influencers.

Teen boys are being encouraged to change the way they look in order to fit a certain standard of attraction. The growing amount of looksmaxxing content they see online can have real effects on their self-esteem and mental health.   

What is looksmaxxing?  

Looksmaxxing originated nearly a decade ago in incel forums where men blamed their lack of romantic partners on the belief that female sexual selection is primarily based on physical qualities. So men who aren’t born with traits desirable to women are doomed to fail romantically. While traditional incels wallow in this fate, looksmaxxers seek to enhance their appearance to become more attractive. Their community claims that there is a universal standard for what the ideal man (and woman) should look like.

This is determined by a rating system called the PSL scale — the name being an amalgamation of three prominent misogynistic incel forums of the 2010s. There are many factors that go into the scaling, such as eye shape, jaw size, nose angle, and body fat percentage. Along this scale, you can land in four categories: subhuman, normie, Chadlite, and Chad (the ultimate catch).

During the pandemic, looksmaxxing went mainstream, merging with “manosphere” content on social media platforms like TikTok and Instagram. The trend became less about the ability to attract women and more of a competition among boys and men as they engaged in mog-offs — online contests where people have their faces analyzed and compared by facial recognition software to determine who’s better looking.

Self-improvement practices have gained popularity among boys. Some are considered to be softmaxxing, like developing skincare routines or eating high-protein diets, and others to be hardmaxxing, like using growth hormones or getting cosmetic surgery.

Prominent young influencers like Clavicular represent the extreme side of looksmaxxing. He practices bonesmashing (using a hammer on facial bones to try to form more angular features), injects himself with testosterone, and takes meth to maintain a low body fat percentage while still having a muscular physique.

Looksmaxxing and new beauty standards

The rise of looksmaxxing seems to have a caused a ripple effect among teen boys. While the ideal look has centered on big muscles and washboard abs for decades, there’s now an added pressure on facial beauty that’s typically been reserved for girls.

“With some of the teen boys I work with, most of whom already have self-esteem issues, I think there is a lot more concern about how they look,” observes Alnardo Martinez, LMHC, director of the Pediatric OCD Intensive Program and a mental health counselor at the Child Mind Institute. “They want to have the strong jaw, really big muscles, clear skin, and a perfect haircut.”

However, Martinez notes that it sometimes take a while for boys  to admit that they feel this pressure. They may insist that they don’t really care about that stuff. “But then, maybe a few months later, it comes out that there is a lot of comparison. They’re spending a lot of time in front of the mirror or in the bathroom trying to create this perfect image,” he observes.

What teen boys think about looksmaxxing and self-improvement

We talked to young men who were critical of Clavicular and the impact looksmaxxing can have on teens but were positive about engaging in some form of physical self-improvement.

Wyatt, now 19, remembers comparing his jawline to his peers’ when he was in 7th grade. “I just felt like they had really sharp jawlines. And I was just like, ‘Oh, I want to get closer to that.’” He would also come across TikToks advertising rubber chewing blocks and chin exercises meant to strengthen the jawline.

And so, Wyatt began to do jaw exercises he’d found online, reciting the alphabet while stretching out the muscles. “I would go through my Zoom classes throughout the day and then after that was done, I’d just go into the bathroom and go through the whole exercise. It would take like an hour sometimes,” he recalls. “It turned into more like a self-care, self-improvement session. I would do that every day after my classes. I didn’t feel like I was done with school until I finished my jawline routine.” He took photos to document his progress.  

Wyatt feels like the routine had a positive effect, because he was able to see an improvement. “I felt more satisfied with myself, a little more confident.”

Lev, now 19, remembers wanting to have some control over his body when going through puberty in high school. “Puberty is not a straightforward process. It’s not all peaches and cream. Your body changes, and it can be uncomfortable,” he explains. “But with lifting and strength training, it was very exciting to see this, you know, man energy that came out of it. I wanted to harness that and really take it by the reins. Have some agency as a man.”

And while he rejects the extreme parts of looksmaxxing, Lev does regularly practice self-improvement through weight lifting, skin care routines, and taking GLP-1 weight loss medication.

How looksmaxxing can impact boys’ mental health

Since looksmaxxing places such a strong emphasis on achieving a very specific look, clinicians are concerned about its influence on teens. “Self-esteem is pretty fragile during puberty,” Martinez says. “There’s already a ton of comparison and perceived flaws that teens don’t love about themselves.”

These insecurities can be exacerbated by the type of content teens engage with online, Martinez explains. Along with ChatGPT bots specifically designed to judge aesthetics, Reddit threads such as r/Mewing and websites like Looksmaxxing Forum encourage boys to post pictures of their faces and bodies to get rated by their peers. Boys as young as 13 visit these forums, posting pictures and asking for tips on how to improve their looks.

“These are generally places where people are already pretty harsh and critical. These boys are receiving a lot more ‘confirmation’ around the perceived things that are wrong with them or that they need to change,” Martinez says. “And it just feeds into the already present negative self-image and self-talk.”

He explains that this type of social media engagement can also compound underlying mental health issues like depression and social anxiety. “They might be less likely to go out and talk to people because they’re thinking, ‘Everyone is going to see this one thing that everyone else has told me is wrong with me. So now I can’t go out,’”he says.

Martinez is also concerned that online content can negatively affect teens with body dysmorphic disorder (BDD). “If they think they have a big nose, for example, they might go on these Reddits and ask, ‘What does my nose look like? Is it too big?’ There are trolls out there. Someone is going to say yes and then that’s going to make the BDD symptoms even worse.”

When behaviors might be concerning

In some ways, teen boys taking part in more self-improvement practices could be seen as a good thing. They’re exercising, taking care of their skin, and eating more balanced diets. The issues begin when these types of practices turn into obsession. And given the underlying ideology of looksmaxxing and the nature of social media, things can become unhealthy.

According to Martinez, there are some changes in behavior to look out for that indicate you might want to step in.

One clear change, he says, is a noticeable shift in the amount of time they’re spending on grooming themselves. “Maybe they were someone who would typically just get up and run out the door without washing their face,” he says. “But now they’re spending a lot more time in the bathroom and asking a lot of questions about how they look.”

Another warning sign can be a big change in personality. “Irritability is a big one that we’ll see a lot,” he says. “They’re unhappy with how they look, so this increases a general level of irritation.”

These behaviors paired with an unusual uptick in time spent on social media, Martinez explains, can be a sign that something’s wrong and support is needed.

How to support your child

If you’re worried that your child might be engaging in looksmaxxing-related behaviors to an unhealthy degree, says Martinez, there are a few things you can do:

  • Open communication. Martinez suggests approaching your child with curiosity. “You could start the conversation by saying something like, ‘So have you heard about this? What do you think about it? Have you ever had any thoughts yourself about how you look or desires to change your body or face?’ And then give them some space to be open and vulnerable about it. Validate their experience.” 
  • Find out where your child is getting their information. “Read it together, talk about it, and see what your child thinks about it,” Martinez advises. “And if it’s promoting something dangerous, then you can talk to them about how those practices can be harmful and what could actually happen if they do some of those things.”
  • Encourage male role models. “There’s a patient I work with now who doesn’t have a present dad,” Martinez explains. “His mom tries to talk to him about things like body image, but he feels like she doesn’t understand and can’t relate. So having someone that he can talk to and be open about this stuff with, especially someone who can also share their own struggles, can be really helpful.”
  • Seek help from a mental health professional. This is especially important if you find out that your child has been engaging in extreme forms of looksmaxxing such as bonesmashing or starvemaxxing. Martinez recommends looking for a clinician who specializes in body image or body dysmorphic disorder.

A lot of parenting comes down to open communication around what your kids are seeing and what they’re feeling. We all have things about our bodies that we might not like and wish we could change, says Martinez, and it can help to normalize those feelings. “And then you can discuss how they can make changes in healthy ways,” he suggests. “Go over what’s a realistic change and what’s a dangerous change.”

The post Boys, Masculinity, and the Looksmaxxing Trend   appeared first on Child Mind Institute.

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The relationship between mobile phone addiction and depression, anxiety among Chinese college students: the mediating role of friendship quality and the moderating effect of preference for solitude

BackgroundThe university stage represents a critical period for the development of individual mental health. Mobile phone addiction is closely linked to depression and anxiety among college students, and both friendship quality and preference for solitude are tightly associated with college students’ mobile phone addiction and emotional health. Therefore, this study aimed to investigate the relationships and internal mechanisms among mobile phone addiction, friendship quality, preference for solitude, depression and anxiety in college students.MethodsA total of 1083 Chinese college students (58.2% female; mean age = 19.87 ± 1.692 years) were included as participants. Data were collected using the Mobile Phone Addiction Index, Friendship Quality Questionnaire, Preference for Solitude Questionnaire, and Depression Anxiety Stress Scale. Data processing and analyses were conducted using SPSS 26.0 and the PROCESS macro.Results(1) Mobile phone addiction was significantly negatively correlated with friendship quality, and significantly positively correlated with both depression and anxiety; friendship quality was significantly negatively correlated with depression and anxiety; preference for solitude was significantly positively correlated with depression and anxiety. (2) Mobile phone addiction not only directly and positively predicted depression and anxiety among college students, but also predicted depression and anxiety through the mediating role of friendship quality. (3) The direct effect of mobile phone addiction on depression and the mediating effect of friendship quality in the relationships between mobile phone addiction and depression/anxiety were both moderated by preference for solitude, whereas the moderating effect of preference for solitude on the association between mobile phone addiction and anxiety was not significant.ConclusionFriendship quality serves as an important mediating pathway between mobile phone addiction and depressive and anxiety symptoms among Chinese college students. Preference for solitude may amplify the associations of mobile phone addiction with poorer friendship quality and elevated depressive symptoms.
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Collaborative care treatment for major depressive disorder

IntroductionMajor Depressive Disorder (MDD) is a burdensome behavioral health condition that is costly and difficult to treat, particularly for patients with severe cases. The Collaborative Care Model (CoCM) has been shown to be effective for moderate depression treatment but less is known about its effectiveness for severe depression. This study analyzes the impact of CoCM treatment on outcomes for depression patients across all ranges of MDD severity at Concert Health.Materials and methodsAnalysis was completed utilizing all closed patient treatment episodes (N = 30,162) at Concert Health between 2018 and 2025. Of these patients, 5,693 began treatment with severe depression. We compare effect sizes for change between baseline and final screener scores across severity levels. Additionally, we utilize logistic regression to complete analyses to understand treatment factors and patient characteristics that are associated with treatment response and remission, as measured by changes in PHQ-9 scores.ResultsThe primary analysis showed that patients with severe depression (PHQ-9 > 20) had slightly lower odds of achieving response compared to patients with moderate depression (OR: 0.93). The treatment factors of insurance type, suicide risk, anxiety presence, and touchpoints also had significant effects on the odds of achieving response and remission.DiscussionThe results suggest that CoCM may be effective for patients with severe depression in achieving treatment response. Patients on Medicaid or with more complex conditions such as anxiety presence or elevated risk for suicide may need higher levels of engagement from the care team to achieve response and remission.
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What Are Intrusive Thoughts?

When a child confesses a frightening thought that seemed to come out of nowhere — “What if I hurt someone with this knife?” “What if mom dies in a car accident?” “What if germs get into this paper cut and I die of an infection?”  — you can both find it confusing and disturbing.  But in most cases these intrusive thoughts are not evidence of a problem.

Intrusive thoughts are unwanted ideas, images, or urges that pop into the mind seemingly out of nowhere. They might feel embarrassing, violent, sexual, or just plain strange — and they feel completely out of character, which is exactly why they’re so upsetting. “An intrusive thought is a lot like your brain sending junk mail,” says Theresa Welles, PhD, a clinical psychologist and director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “Just because it shows up doesn’t mean it’s important or true or something you even want.”

It also doesn’t necessarily mean that a child has OCD or another mental health disorder. Though intrusive thoughts are associated with OCD — in which unwanted thoughts (called obsessions) drive children to perform rituals (called compulsions) to alleviate them — for many children they are just fleeting thoughts. It’s only when kids become unable to let them go that they are concerning. Another way to think about it, says Dr. Welles, is that “the brain’s job is to generate thoughts, the same way an apple tree’s job is to produce apples. Not every apple is perfect — some are misshapen or wormy. And not every thought is meaningful or worth paying attention to. Having a thought is not the same as wanting it or intending to act on it.”

Who has intrusive thoughts

“Everyone who has a brain has them,” says Caitlyn Downie, LCSW, director of trauma and resilience at the Child Mind Institute. “It’s part of the human existence.” A child might suddenly imagine something terrible happening to a parent, or a teenager might have a violent or sexual thought that feels shocking or shameful. Most of the time, these pass quickly — unpleasant, but easy enough to brush aside.

That’s the key distinction: not the thought itself, but what happens after it. The concern isn’t that the thought appeared — it’s how the child responds, how often it returns, and whether it starts getting in the way of daily life.

For some children — particularly those who are anxious, perfectionistic, or who have OCD — intrusive thoughts become “sticky.” Instead of passing through, the thought snags. The child starts paying attention to it, trying to figure it out or make it go away, which only makes it feel more powerful. “Young people lack the experience to recognize that thoughts aren’t the same as intentions, desires, or actions,” Dr. Welles says. “The thoughts feel alarming. So the child pays more attention, and the more attention they give it, the more often it returns.” That loop of fear and self-doubt is what parents and clinicians need to be alert to.

When should parents be concerned?

Many children are too ashamed or frightened to describe what’s actually going on, so parents may never hear about the thought itself. Instead, changes in behavior are often the first clue. Look for signs like:

  • Increased distress, irritability, or moodiness
  • Avoidance of something that wasn’t previously a problem
  • Trouble concentrating or sleeping
  • Excessive guilt or repeated reassurance seeking
  • Rituals like checking, counting, washing hands, or going through routines in a specific way

It’s worth seeking professional support when intrusive thoughts are frequent and intense, hard to shake, causing real distress, or getting in the way of school, friendships, or daily routines.

Why intrusive thoughts feel so frightening

When an intrusive thought appears, it can set off the body’s alarm system — the same ancient survival mechanism that helped people run from danger or fight it off. In anxiety and OCD, that alarm bell rings when there’s no real emergency. The child has a thought, the body reacts with panic, and the child assumes the thought must be important because it feels big and important.

Children may also fall into what clinicians call thought-action fusion. “That’s the mistaken belief that having a thought makes it more likely to happen,” explains Dr. Welles, “or that it reveals something terrible about who they are.” A child who thinks, “What if I hurt my baby brother?” may become convinced the thought means they secretly want to — but intrusive thoughts are often the precise opposite of what a child would ever want. Paradoxically, Dr. Welles says, “for most people with anxiety disorders and OCD, these thoughts are the actual opposite of what they would ever do.”

How parents can help

The first thing to do is stay calm — harder than it sounds if the thought is violent, sexual, or taboo. Children look to their parents to gauge whether something is truly dangerous, so if you look horrified, your child takes that as confirmation the thought is something to fear.

When a child shares an intrusive thought, Downie suggests responding with warmth and curiosity: “Say something like, ‘I appreciate you telling me — it sounds like that was really scary.’ It also helps to normalize it: ‘A lot of people have thoughts they don’t particularly like.’” Some other responses that can help:

  • “That sounds really upsetting — I’m glad you told me.”
  • “Having a thought doesn’t mean you want it or that it’ll ever happen.”
  • “You don’t have to figure this out right now.”

The goal is to help your child feel less alone and less ashamed, without treating the thought like a five-alarm emergency. And do your best to avoid reassurance. Reassuring the child about the contents of a specific thought (for example, responding to a child who asks, “Are you sure I’m a good person?” with “Yes, you’re a good person”) can actually make things worse, especially in kids with OCD. They feel very temporary relief but then the thought creeps back and they need more reassurance. It becomes a cycle. Instead try: “I know this feels awful. And I know you can handle it.”

It also helps to redirect the child to something concrete: getting dressed, eating breakfast, watching a show, texting a friend. With younger kids, you might guide them in doing slow breaths or suggest they move to another room so they distract themselves from the thought. With teens, you might mean teach them to resist the urge to Google their fears or thoughts, confess, or ask the same question over and over again. “The idea,” Downie says, “is to validate the feeling without validating the fear. You’re saying: ‘I hear you, this is hard, and you can get through it.’”

What can cause intrusive thoughts?

Intrusive thoughts aren’t a diagnosis on their own — they’re a symptom that can show up across a range of conditions, or in children who have no diagnosis at all. Disorders they may be associated with include:

  • OCD: The most closely associated condition. Common themes include harm, contamination, sexual thoughts, and religious or moral fears.
  • Generalized anxiety: Tends to involve repetitive “what if” worries about everyday concerns — school, safety, family, the future.
  • Social anxiety: Brings intrusive thoughts about embarrassment, rejection, or being judged by peers.
  • PTSD: Can involve intrusive memories, images, or sensations tied to a traumatic event. “A child who has experienced trauma may worry about being harmed again or even about harming someone else,” Downie notes, “but that doesn’t mean every child with trauma will have intrusive thoughts.”
  • Depression: Often involves intrusive thoughts that fit a negative self-image: I’m worthless. I’m a burden. I’m a bad person.
  • Autism spectrum disorder: Repetitive thoughts often center on a special interest and aren’t typically unwanted or distressing the way OCD thoughts are — though they can look similar from the outside.
  • Psychotic disorders: Young people with psychosis tend to experience intrusive thoughts as fixed and real, without the self-awareness that typically accompanies anxiety-driven ones. Psychotic disorders such as schizophrenia are rare in children, though early signs can appear in the teenage years.

How intrusive thoughts are treated

Treatment depends on what’s driving the thoughts and how much they’re disrupting the child’s life:

  • For OCD, the gold-standard treatment is exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy (CBT) where children practice sitting with intrusive thoughts without doing compulsions. Over time, they learn to tolerate uncertainty and discover that the thought, however uncomfortable, isn’t actually dangerous.
  • For anxiety, the same treatments are helpful. CBT helps children understand the connection between thoughts, feelings, and behaviors, and ERP helps kids learn to tolerate the anxiety these thoughts generate, and it gradually diminishes.
  • For trauma, treatment may include trauma-focused CBT. Mindfulness, DBT skills, and breathing exercises can also help regulate the nervous system.
  • Family involvement matters a great deal. “Parents often need help learning how to respond without accidentally feeding the anxiety cycle,” Dr. Welles says. SPACE (Supportive Parenting for Anxious Childhood Emotions) is an evidence-based approach that helps parents reduce accommodation and support their child’s brave behavior instead.
  • For moderate-to-severe OCD or anxiety, medication — typically an SSRI — may also be worth discussing with a psychiatrist or pediatrician.

Helping your child trust their own mind

One of the hardest things about intrusive thoughts is that they can make children afraid of their own minds — convinced that every thought needs to be examined or explained away before they can relax. But no one gets to have only pleasant, well-behaved thoughts.  

What children can learn is that a thought can be upsetting without being meaningful, loud without being true, and it can pass through without becoming a verdict on who they are. As parents, the most powerful thing you can offer is a calm, steady presence — taking it seriously without treating it as a catastrophe. When your child sees you aren’t panicked, they get to borrow some of that calm for themselves.

Frequently Asked Questions

What are intrusive thoughts?

Intrusive thoughts are unwanted ideas, images, or urges that pop into your mind unexpectedly. They often feel upsetting or out of character, but they’re essentially “junk mail” from the brain — not meaningful or important.

Are intrusive thoughts normal?

Yes, everyone can have them. Most children (and adults) experience intrusive thoughts at times, and in many cases they pass quickly without causing problems.

What causes intrusive thoughts?

They’re a normal byproduct of how the brain works, but they can become more frequent or “sticky” in kids who are anxious, perfectionistic, or dealing with conditions like OCD or trauma. Paying extra attention to the thought can also make it return more often.

Do intrusive thoughts mean I want to act on them?

No. Having an intrusive thought doesn’t mean you want to act on it or that it reflects who you are. In fact, these thoughts are often the opposite of what someone would ever want or do.

The post What Are Intrusive Thoughts? appeared first on Child Mind Institute.

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Treating ADHD With Methylphenidate (Ritalin, Concerta)

Methylphenidate is a stimulant medication used to treat symptoms of ADHD. It helps the brain regulate attention, focus, and impulsive behaviors.

It’s one of the two stimulants widely used in ADHD medications. Methylphenidate is the active ingredient in Ritalin and Concerta, among others. The other commonly used stimulant, amphetamine, is the active ingredient in Adderall and Vyvanse, among others. Both stimulants work by increasing levels of dopamine and norepinephrine, chemicals in the brain that control attention, focus, and impulsivity. If a child doesn’t do well on the first stimulant medication they try, they may respond better to a different formulation of that type or the other type of stimulant.

How is methylphenidate different from amphetamine?

Methylphenidate is somewhat less powerful than amphetamine and tends to have milder side effects.

If your child is under 12 and has just been diagnosed with ADHD, a doctor is likely to prescribe a methylphenidate medication first, to see how well the medication reduces their ADHD symptoms, and whether the side effects are problematic.

Methylphenidate is also many doctors’ first choice for younger children because it has been used to treat ADHD much longer than amphetamine. Ritalin (methylphenidate-based) was FDA approved in 1955, while Adderall (amphetamine-based) wasn’t approved until 1996. In countries outside the United States, amphetamine-based ADHD medications are less widely approved than those based on methylphenidate.

How methylphenidate works vs amphetamine

The two stimulants target the same brain chemicals but work slightly differently, says Paul Mitrani, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. Methylphenidate increases the levels of dopamine and norepinephrine by blocking what’s called reuptake — the process by which nerve cells reabsorb these chemicals after they’ve been released. As Dr. Mitrani describes it, methylphenidate “enhances” the norepinephrine and dopamine the brain naturally releases by making the chemicals stay around longer. It boosts the stimulation the brain is already getting from whatever activity the child is engaged in.

Amphetamine, on the other hand, not only blocks reuptake but stimulates the release of more dopamine and norepinephrine, which is why it’s considered stronger. “Adding stimulation with amphetamine sometimes helps,” he notes. “But sometimes that added stimulation is too much, and it increases side effects the child experiences.”

Kids vary in how they respond to methylphenidate vs amphetamine

There is individual variation in how children respond to the two stimulants. So if methylphenidate doesn’t give the desired symptom relief or produces problematic side effects, it’s recommended practice to try amphetamine, or vice versa. Research shows that 70 percent of children with ADHD respond to a trial of methylphenidate. More than 90 percent will have a beneficial response to one of the stimulants if both methylphenidate and amphetamine are tried. Studies also show that approximately 41 percent respond equally well to both types of stimulant.

Children can also vary in their response to different formulations of the same stimulant, which affect the rate at which the medication goes into the bloodstream.  For instance, a short-acting form of Ritalin will kick in quickly and last for 3-4 hours, while Concerta, a delayed-release formula, lasts as long as 10-12 hours. It’s very common for kids to try several before finding the best fit.

What are the side effects of stimulant medications?

Methylphenidate and amphetamine have the same side effects, though they may be less intense with the former.

Appetite suppression

The most common side effect of stimulants is appetite suppression. It can be especially concerning with long-acting forms of the medication, which are often preferred to get better coverage through the school day. Kids who take a long-acting stimulant in the morning tend to lose their appetite for lunch and may not be interested in eating until after dinnertime.

When this is a problem, Dr. Mitrani notes that taking a shorter-acting form of the medication can help. “For instance, Concerta is a methylphenidate medication that lasts for a long time and can suppress appetite for 10–12 hours.” An alternative might be a medication that lasts for 6–8 hours, such as Metadate CD or Ritalin LA. Some children with more pronounced problems with appetite will do better on a short-acting dose in the morning and then another after lunch, he adds, since it gives them a break during the day where they can eat better.

Sleep issues

Kids who take stimulant medication can have trouble falling asleep. This can happen when a long-acting medication or an afternoon dose of a short-acting medication wears off and they get restless or hyperactive around bedtime. Difficulty falling asleep can get better after a few weeks, but if it doesn’t, it may be helpful to change either the timing or the type of the medication that is given. It’s also important to explore whether there are other contributors to sleep challenges, such as worry, screen time too close to bedtime, or lack of a consistent evening routine that helps kids calm down.

Irritability

Stimulant medications can generate agitation and irritability, which can be especially problematic in kids who are already anxious. For children with anxiety, this can be another reason to start treatment with methylphenidate, because amphetamines can feel more activating.

But Dr. Mitrani notes that treating ADHD can also reduce anxiety: “Some kids are so stressed about school — because they can’t pay attention or arealways getting in trouble — that when you treat the ADHD, they are better able to manage the demands of school and become less anxious.”

That reduction in school anxiety can also affect what happens when they get home from school. “When there is anxiety, it’s like kids are holding it together at school, and then they come home after a stressful day and just let it out,” he says. “So if the school day is less stressful, you may also see that come down at the end of the day.”

Mood changes

Some children report that stimulant medications seem to dull their personality. Dr. Mitrani suggests that this may be connected to the medication stimulating the prefrontal cortex, the part of the brain that not only manages attention and focus, but also helps regulate emotions and impulse control in other brain areas. “Enhanced control of the emotional part of the brain can cause this feeling of dullness,” he notes. “Some people will even say they feel depressed, that they’re just not like themselves because they don’t have the same energy or personality.”

If this happens to a child on methylphenidate, Dr. Mitrani will recommend trying an amphetamine or a non-stimulant medication.

Rebound effects

Some families report that their child is irritable or emotional after school or at the end of the day, when the stimulant medication is wearing off. Dr. Mitrani notes that this can coincide with the child being hungry after missing lunch. It can also be connected to the medication level dropping too quickly, and strategies that create a more gradual decrease may help take it away. For example, he might suggest adding a small dose of  short-acting form of the stimulant a half hour before the morning medication wears off.

Starting children on methylphenidate

Dr. Mitrani usually starts a child on a short-acting form of methylphenidate for two reasons: as a quick test to see if the child will experience side effects and to have an opportunity to try it twice in a day, to have more chances to assess for positive changes.

He recommends starting the medication on a weekend or a break from school and giving the child some tasks that are challenging for them because of their ADHD, like reading or something else that requires concentration, such as cleaning their room or doing household chores. “After lunch you want to try it again, to have another time point to check on. Because if you only give one dose of the medication, you don’t know if the child’s behavior was a result of the medication or some other factor. The more data points that we have, or more trials, the more information we get.”

He recommends keeping the child on short-acting doses for at least several days before trying a longer-acting formula.

Starting children on a low dose

Practice guidelines for psychiatrists recommend starting children on a low dose to assess any side effects the child might experience and gradually increasing it over 1-2 weeks with careful monitoring of response until you reach the minimum dose that will give the best symptom relief.

There is a great deal of variation in how children respond to these medications, so starting with an “average” effective dose, even adjusted by body weight, would be under-medicating some kids and overmedicating others.

For instance, for a 6- or 7-year-old child, a common starting dose of a short-acting medication might be about 2.5 mg, going up to 5 mg if more is needed for symptom relief and side effects are not an issue, Dr. Mitrani says. 

Liquid versions of either stimulant have an advantage when it comes to getting exactly the right dose, he notes: “You can do, 1 milliliter, 1.5, 1.6, depending on the syringe.”

Long-acting formulations that come in capsules can be especially frustrating, he adds — since they come in set doses and can’t be opened and divided effectively, because the beads inside are made to be triggered at different time periods.

Trying different formulations

Dr. Mitrani stresses that small differences in the formulation of a medication can make a difference in a child’s reaction.

For instance, Focalin (dexmethylphenidate) is a refined form of methylphenidate. Standard methylphenidate medications contain two mirror-image forms, or isomers, but most of the benefit comes from one of them. Focalin contains only this more active isomer. For some children, it works better, causes fewer side effects, or feels smoother.

He also notes that variations in the release patterns among long-acting formulations can affect a child’s experience. “Take Concerta, which has a unique mechanism for the extended release,” he explains. “There are three phases: a really immediate phase, then a regular Ritalin kind of phase and, then a slow extrusion of the remaining methylphenidate throughout the day that helps it last as long as 12 hours.”

By contrast, he describes Ritalin LA, which tends to last for 6-8 hours, as “50-50” — 50 percent of the dose is immediate released and the other half is delayed release. Other formulations are “40-60” or “30-70.” “These subtle differences can result in some kids responding better to one than the other, while other kids can do well on any of them.”

So even within the methylphenidate group, there may be reason to try a child on number of different formulations to get the best fit. And, of course, other reasons for trying different versions are limits on what insurance covers —which can change suddenly — and what’s available because of shortages. “And that can be really frustrating for families,” he says. “What I hear is, ‘My child was on Concerta or on Metadate CD and they made me switch to this one and now my kid’s not doing as well.’ “


When families cannot get a medication that has been working, finding another medication that’s available, that’s effective, and that insurance will approve can be a lot of hoops to jump through, he adds.

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Perspectives on Continuous Glucose Monitoring Among Adults with Type 2 Diabetes in the United Kingdom: Cross-Sectional Survey

<strong>Background:</strong> Type 2 diabetes (T2D) is one of the most common noncommunicable diseases, requiring ongoing lifestyle changes and continuous glucose management through medication, diet, and physical activity. Traditional self-monitoring of blood glucose can be burdensome, especially with frequent finger pricks. As continuous glucose monitoring (CGM) becomes more affordable and accessible, it offers benefits such as increased glucose awareness, behavioral modifications, and reduced anxiety. However, challenges remain, including cost, discomfort, skin reactions, and privacy concerns. In the United Kingdom, perceptions of CGM among people with T2D, including both users and nonusers, are not well understood, limiting insight into factors influencing adoption and sustained use. <strong>Objective:</strong> This study aims to explore how adults with T2D perceive the benefits and challenges of using CGM, including both current users and nonusers. <strong>Methods:</strong> This study used a cross-sectional, online survey using YouGov’s nationally representative panel to explore experiences of CGM among adults with T2D in the United Kingdom. A total of 531 participants were recruited from November to December 2024. Thematic analysis of responses to 2 open-ended questions identified key perceived benefits and challenges associated with CGM use. <strong>Results:</strong> A total of 531 adults with T2D completed the YouGov online survey. Over half were male (297/531, 55.9%) and aged 65 years and older (281/531, 52.9%). Two-thirds (347/531, 65.3%) had lived with T2D for more than 5 years, and 9.6% (51/531) use or had previously used a CGM. Overall, 50.8% (270/531) responded to at least one free-text question, with 49% (260/531) commenting on benefits and 33.1% (176/531) on challenges. Thematic analysis identified five key benefit themes: (1) reduced monitoring burden, described as eliminating frequent finger prick testing and simplifying daily routines; (2) lifestyle feedback, enabling participants to better understand how diet and physical activity influence glucose levels; (3) greater control, by supporting more informed decision-making and increasing confidence in self-management; (4) feeling safer, through alerts for hypo- and hyperglycemia; and (5) sharing data with clinicians, which facilitated communication and more collaborative care. The main challenges were (1) access barriers, including restrictive eligibility criteria and the high cost of self-funding; (2) device issues, such as discomfort, inconvenience, and practical difficulties wearing the sensor; (3) technology reliance, with concerns about depending on devices rather than listening to bodily cues; (4) emotional strain, including anxiety, over-monitoring, and increased preoccupation with glucose levels; and (5) data concerns, particularly regarding accuracy, interpretation, and privacy. <strong>Conclusions:</strong> Adults with T2D, including both users and nonusers, described CGM as a practical and empowering tool that improves understanding, safety, and collaboration with health care providers. Nevertheless, access barriers, usability issues, and emotional and data-related burdens remain major obstacles to equitable adoption. Addressing these through improved affordability, digital literacy support, and customized clinical guidance may support ongoing and inclusive CGM use in routine care.
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Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential

By Florencia Assaneo, PhD, Research Fellow, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Educational challenges for Latin American children

Primary education in Latin America has faced a steady decline over recent decades, contributing to what many organizations now describe as an educational crisis. International institutions such as the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Educational, Scientific and Cultural Organization (UNESCO), as well as the World Bank Group have all called for urgent action to address worsening learning outcomes across the region. The situation is particularly concerning in Mexico. Results from the 2022 Programme for International Student Assessment showed that Mexico scored well below the Organization for Economic Co-operation and Development (OECD) average in reading, mathematics, and science — placing the country among the lower-performing educational systems evaluated globally.

The consequences of this crisis extend far beyond the classroom. Educational difficulties during childhood are closely linked to long-term social and mental health outcomes. Research has shown that additional years of basic education are associated with lower rates of depression and anxiety (Kondirolli & Sunder, 2022), as well as higher levels of resilience and perceived control over one’s life (Niemeyer et al. 2019). In this sense, poor academic performance in primary school can have lasting effects that continue into adulthood, limiting employment opportunities, increasing vulnerability, and negatively affecting overall well-being.

Can rhythm-based video games improve learning?

Open-access interventions that strengthen children’s cognitive and academic abilities could have enormous value in low- and middle-income countries, where educational resources are often limited. Our work explores whether the ability to coordinate movements with rhythmic sounds — such as clapping, tapping, or dancing to music — can be leveraged to support children’s learning and cognitive development through engaging digital tools.

Over the last decade, multiple studies have shown that children who are better at synchronizing their movements to rhythm also tend to perform better on a wide range of cognitive and language-related tasks. These include reading, phonological awareness, processing speed, rapid naming, and other foundational abilities linked to academic success. Researchers have assessed these rhythmic coordination skills in multiple ways, from walking to the beat of music to tapping along with a steady rhythm or coordinating movements while playing musical instruments. Across these different approaches, one result consistently emerges: children who are better at aligning movement with sound also tend to show stronger cognitive performance.

Building on these study findings, my current fellowship project, supported by the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute, seeks to better understand how these rhythm synchronization abilities develop during childhood and whether they could eventually be strengthened through interactive digital interventions. Specifically, we are studying the developmental stage at which these abilities become established in children, and whether individuals with stronger rhythmic coordination also show advantages in attention and language-related skills. Understanding when these abilities emerge is particularly important because it may help identify the developmental window during which they are most malleable and therefore most responsive to training or intervention.

Public school “Américas Unidas” in Querétaro, Mexico.
From left to right: Rebeca Hernández Soto, associated researcher at the lab; M. Florencia Assaneo; principal of the public primary school; and Moramay Ramos Flores, a PhD student working on the project. At the public school “Américas Unidas” in Querétaro, Mexico. 

In parallel, we are using functional magnetic resonance imaging (fMRI) — a non-invasive brain imaging technique that allows us to observe which brain regions become active during different tasks — to explore the relationship between rhythmic synchronization and the brain’s reward system. Importantly, these same reward-related regions are also strongly engaged during video game play. If the pathways within this reward system are similarly activated during rhythmic coordination, this could mean that children who initially struggle to synchronize movements with sound may be able to strengthen these abilities through a carefully designed video game experience. One possible future application could involve an open-access mobile game in which children synchronize taps or hand movements to musical rhythms while progressing through increasingly challenging levels and unlocking rewards or visual customizations.

Overall, the current project seeks to generate the scientific evidence necessary to determine whether rhythm-based digital interventions could become a viable tool for supporting children’s cognitive development. This work has the potential to contribute to the future development of accessible and scalable tools that can strengthen foundational cognitive skills linked to academic performance in children. These tools can be applied to children in Mexico and, more broadly, across low- and middle-income countries (LMICs), expanding access to education resources and interventions.

The power of collaboration between the SNF Global Center and UNAM

Our laboratory at Universidad Nacional Autónoma de México (UNAM) is primarily dedicated to basic neuroscience research. Based at UNAM’s campus in Querétaro, our team brings together researchers and students from different disciplines — including neuroscience, psychology, physics, engineering, and data analysis — united by a shared interest in understanding how rhythm and brain dynamics shape human cognition and behavior. Here, we have access to excellent infrastructure for fundamental research, including neuroimaging facilities and high-performance computational resources. However, translating basic scientific discoveries into interventions capable of improving people’s daily lives is often much more challenging and requires strong cross-sector collaboration.

Members of the research team at the laboratory facilities on UNAM’s Querétaro campus.  
Members of the research team at the laboratory facilities on UNAM’s Querétaro campus.  

The work I’m conducting as part of the SNF Global Center Research Fellowship has encouraged us to begin thinking beyond the laboratory. This current fellowship has given us the opportunity to test the core scientific assumptions behind our proposed open-access intervention. If the pilot project proves successful, the next stages of the work will become considerably more ambitious, involving both the technological development of the intervention and its large-scale implementation and evaluation in school settings. Advancing toward those goals will likely require the support of larger international organizations and cross-sector collaborations. In this context, the opportunities provided by the SNF Global Center at the Child Mind Institute to share, disseminate, and give visibility to our work are extremely valuable, helping create the connections and momentum necessary to move from foundational research toward real-world impact.

More broadly, this kind of collaboration highlights the importance of building bridges between global institutions and local research communities. By combining international support with local expertise and close engagement with schools and communities, it becomes possible to develop solutions that are both scientifically rigorous and genuinely connected to the realities of the populations they aim to serve.

Learn more about the Research Fellowship

The post Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential appeared first on Child Mind Institute.

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Young Adults’ Perspectives on an Ecological Momentary Intervention for Drinking to Cope: Qualitative Study

<strong>Background:</strong> Young adults have high rates of mental health problems, such as mood or anxiety symptoms, and high rates of problematic drinking. Many young adults who undergo psychiatric hospitalization to address depression and anxiety symptoms also engage in risky drinking and tend to drink to cope with negative emotions. However, in many cases, treatment programs focusing on mood and anxiety symptoms often fail to adequately address problematic alcohol use in young adults. <strong>Objective:</strong> This study aimed to address this treatment gap by investigating patient perspectives on a potential ecological momentary intervention mobile app. Researchers used qualitative methods to gather perspectives of young adults hospitalized for psychiatric care on their use of drinking to cope with negative emotions and their feedback for a prospective app designed to suggest healthy coping strategies when participants report low mood and cravings to drink. <strong>Methods:</strong> We recruited a total of 12 young adults admitted to a partial hospitalization program to participate in a qualitative interview. To be eligible, participants needed to be aged 18-25 years and report drinking at least once weekly, binge drinking at least once monthly, drinking to cope with negative emotions, and depression and/or anxiety symptoms. <strong>Results:</strong> Qualitative analysis of our data resulted in 4 major themes. These included (1) motivations to use substances, (2) healthy coping, (3) general reactions to the proposed app, and (4) suggestions for the app. Participants generally had insight about their use of alcohol to cope and were able to identify several motivations for drinking; the most frequent motivations were to alleviate anxiety and depression, although many participants noted drinking to cope with other emotions, such as guilt or loneliness. Participants overall had positive responses to the prospective intervention and reported that they would appreciate the portability of a digital intervention in helping them “step down” from higher levels of psychiatric care. Participants also made several valuable suggestions about content, features, and usability, such as suggesting ways to “gamify” the app to increase use. <strong>Conclusions:</strong> This feedback will be crucial in designing and testing an ecological momentary intervention designed to reduce drinking to cope in young adults hospitalized for psychiatric care.
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Angry Kids: Dealing With Explosive Behavior

When a child — even a small child — melts down and becomes aggressive, they can pose a serious risk to themselves and others, including parents and siblings.

It’s not uncommon for kids who have trouble handling their emotions to lose control and direct their distress at a caregiver — screaming and cursing, throwing dangerous objects, or hitting and biting. It can be a scary, stressful experience for you and your child, too. Children often feel sorry after they’ve worn themselves out and calmed down.

So what are you to do?

It’s helpful to first understand that behavior is communication. A child who is so overwhelmed that they are lashing out is a distressed child. They don’t have the skill to manage their feelings and express them in a more mature way. They may lack language, impulse control, or problem-solving abilities.

Sometimes parents see this kind of explosive behavior as manipulative. But kids who lash out are usually unable to handle frustration or anger in a more effective way — say, by talking and figuring out how to achieve what they want.

Nonetheless, how you react when a child lashes out has an effect on whether they will continue to respond to distress in the same way or learn better ways to handle feelings so they don’t become overwhelming.

Behavioral techniques for anger management

Here are some pointers to help kids learn techniques to regulate their emotions:

  • Stay calm. Faced with a raging child, it’s easy to feel out of control and find yourself yelling at them. But when you shout, you have less chance of reaching them. Instead, you will only be making them more aggressive and defiant. As hard as it may be, if you can stay calm and in control of your own emotions, you can be a model for your child and teach them to do the same thing.
  • Don’t give in. Don’t encourage them to continue this behavior by agreeing to what they want in order to make it stop.
  • Praise appropriate behavior. When they have calmed down, praise them for pulling themselves together. And when they do try to express their feelings verbally, calmly, or try to find a compromise on an area of disagreement, praise them for those efforts.
  • Help them practice problem-solving skills. When your child is not upset is the time to help them try out communicating their feelings and coming up with solutions to conflicts before they escalate into aggressive outbursts. You can ask them how they feel and how they think you might solve a problem.
  • Time-outs and reward systems. Time-outs for nonviolent misbehavior can work well with children younger than 7 or 8 years old. When using time-outs, be sure to be consistent with them and balance them with other, more positive forms of attention. If a child is too old for time-outs, you want to move to a system of positive reinforcement for appropriate behavior — points or tokens toward something they want.
  • Avoid triggers. Vasco Lopes, PsyD, a clinical psychologist, says most kids who have frequent meltdowns do it at very predictable times, like homework time, bedtime, or when it’s time to stop playing, whether it’s Legos or video games. The trigger is usually being asked to do something they don’t like, or to stop doing something they do like. Time warnings (“we’re going in 10 minutes”), breaking tasks down into one-step directions (“first, put on your shoes”), and preparing your child for situations (“please ask to be excused before you leave Grandma’s table”) can all help avoid meltdowns.

What kind of tantrum is it?

How you respond to a tantrum also depends on its severity. The first rule in handling nonviolent tantrums is to ignore them as often as possible, since even negative attention, like telling the child to stop, can be encouraging.

But when a child is getting physical, ignoring is not recommended since it can result in harm to others as well as your child. In this situation, Dr. Lopes advises putting the child in a safe environment that does not give them access to you or any other potential rewards.

Critics of time-outs argue that they can be emotionally isolating for kids, but research shows that they are effective and do not cause children harm. (For more on the debate around time-outs, read our full article on the topic.) However, it’s very important to use them as just one technique in a nurturing, supportive parenting strategy. Be sure to balance use of time outs with lots of praise for kids’ positive behaviors. It’s also important to manage your own stress so that kids can learn how to regulate their emotions from your positive example.

If the child is young (usually 7 or younger), try placing them in a time out chair. If they won’t stay in the chair, take them to a backup area where they can calm down on their own without anyone else in the room. Again, for this approach to work there shouldn’t be any toys or games in the area that might make it rewarding.

Your child should stay in that room for one minute and must be calm before they are allowed out. Then they should come back to the chair for time out. “What this does is gives your child an immediate and consistent consequence for their aggression and it removes all access to reinforcing things in their environment,” explains Dr. Lopes.

If you have an older child who is being aggressive and you aren’t able to carry them into an isolated area to calm down, Dr. Lopes advises removing yourself from their vicinity. This ensures that they are not getting any attention or reinforcement from you and keeps you safe. In extreme instances, it may be necessary to call 911 to ensure your and your child’s safety.

Help with behavioral techniques

If your child is doing a lot of lashing out — enough that it is frequently frightening you and disrupting your family — it’s important to get some professional help. There are good behavioral therapies that can help you and your child get past the aggression, relieve your stress, and improve your relationship. You can learn techniques for managing their behavior more effectively, and they can learn to rein in disruptive behavior and enjoy a much more positive relationship with you.

  • Parent-child interaction therapy (PCIT). PCIT has been shown to be very helpful for children between the ages of 2 and 7. The parent and child work together through a set of exercises while a therapist coaches parents through an ear piece. You learn how to pay more attention to your child’s positive behavior, ignore minor misbehaviors, and provide consistent consequences for negative and aggressive behavior, all while remaining calm.
  • Parent management training (PMT). PMT teaches similar techniques as PCIT, though the therapist usually works with parents, not the child.
  • Collaborative and Proactive Solutions (CPS). CPS is a program based on the idea that explosive or disruptive behavior is the result of lagging skills rather than, say, an attempt to get attention or test limits. The idea is to teach children the skills they lack to respond to a situation in a more effective way than throwing a tantrum.

Figuring out explosive behavior

Tantrums and meltdowns are especially concerning when they occur more often, more intensely, or past the age in which they’re developmentally expected — those terrible twos up through preschool. As a child gets older, aggression becomes more and more dangerous to you, and the child. And it can become a big problem for them at school and with friends, too.

If your child has a pattern of lashing out it may be because of an underlying problem that needs treatment. Some possible reasons for aggressive behavior include:

  • ADHD: Kids with ADHD are frustrated easily, especially in certain situations, such as when they’re supposed to do homework or go to bed.
  • Anxiety: An anxious child may keep their worries secret, then lash out when the demands at school or at home put pressure on them that they can’t handle. Often, a child who “keeps it together” at school loses it with one or both parents.
  • Undiagnosed learning disability: When your child acts out repeatedly in school or during homework time, it could be because the work is very hard for them.
  • Sensory processing issues: Some children have trouble processing the information they are taking in through their senses. Things like too much noise, crowds and even “scratchy” clothes can make them anxious, uncomfortable, or overwhelmed. That can lead to actions that leave you mystified, including aggression.
  • Autism: Children with autism spectrum disorder are often prone to meltdowns when they are frustrated or faced with unexpected change. They also often have sensory issues that make them anxious and agitated.

Given that there are so many possible causes for emotional outbursts and aggression, an accurate diagnosis is key to getting the help you need. You may want to start with your pediatrician. They can rule out medical causes and then refer you to a specialist. A trained, experienced child psychologist or psychiatrist can help determine what, if any, underlying issues are present.

When behavioral plans aren’t enough

Professionals agree, the younger you can treat a child, the better. But what about older children and even younger kids who are so dangerous to themselves and others that behavioral techniques aren’t enough to keep them and others around them safe?

  • Medication. Medication for underlying conditions such as ADHD and anxiety may make your child more reachable and teachable. Kids with extreme behavior problems are often treated with antipsychotic medications like Risperdal or Abilify. But these medications should be partnered with behavioral techniques.
  • Holds. Parent training may, in fact, include learning how to use safe holds on your child so that you can keep both them and yourself out of harm’s way.
  • Residential settings. Children with extreme behaviors may need to spend time in a residential treatment facility — sometimes, but not always, in a hospital setting. There, they receive behavioral and, most likely, pharmaceutical treatment. Therapeutic boarding schools provide consistency and structure around the clock, seven days a week. The goal is for the child to internalize self-control so they can come back home with more appropriate behavior with you and the world at large.
  • Day treatment. With day treatment, a child with extreme behavioral problems lives at home but attends a school with a strict behavioral plan. Such schools should have trained staff prepared to safely handle crisis situations.

Explosive children need calm, confident parents

It can be challenging work for parents to learn how to handle an aggressive child with behavioral approaches, but for many kids it can make a big difference. Parents who are confident, calm, and consistent can be very successful in helping children develop the anger management skills they need to regulate their own behavior.

This may require more patience and willingness to try different techniques than you might with a typically developing child, but when the result is a better relationship and happier home, it’s well worth the effort.

Frequently Asked Questions

How can you deal with children’s anger?

One way to handle a child’s anger is to stay calm when they lose their temper. Controlling your emotions sets an example for the child. You can praise them when they express their feelings calmly and when they calm themselves down after an explosion. Adults who are confident, calm, and consistent help children develop the skills to regulate their behavior.

How do I teach a child to control their anger?

In parent-child interaction therapy, a therapist coaches parents on how to pay more attention to positive behavior, ignore minor misbehaviors, and provide consistent consequences for negative and aggressive behavior, all while remaining calm. Other forms of therapy also center on teaching the parent how to model emotional stability.

How can I calm a child down when angry?

Stay calm and ensure they are in a safe space. Yelling can escalate aggression. Speak in a steady voice, avoid giving in, and use time-outs to prevent meltdowns. When they calm down, praise them for it and for expressing their emotions appropriately. If they are frequently aggressive, behavioral therapy may help.

How do I help a child with anger issues?

Children who lash out often lack the skills to manage emotions. Identifying triggers, teaching problem-solving, and using praise or rewards can encourage better behavior. Time-outs work for younger kids, while older ones may need structured reinforcement. If outbursts are severe, you might need professional help. Programs like parent-child interaction therapy (PCIT), parent management training (PMT), or collaborative and practical solutions (CPS) can help.

The post Angry Kids: Dealing With Explosive Behavior appeared first on Child Mind Institute.

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Associations between childhood trauma, intolerance of uncertainty, and symptom severity in obsessive-compulsive disorder

BackgroundChildhood trauma (CT) has been associated with obsessive-compulsive disorder (OCD), but its relationship with obsessive-compulsive symptom (OCS) severity remains inconsistent. Intolerance of uncertainty (IU) may represent one of the cognitive processes underlying this association. The present study aimed to examine differences in CT and IU between patients with OCD and healthy controls (HCs), and to test whether IU mediates the relationship between CT and OCS severity.MethodsThis study included 82 patients with OCD and 82 healthy controls (HCs) matched on age and sex. CT was assessed using the Childhood Trauma Questionnaire-33 (CTQ-33), IU using the Intolerance of Uncertainty Scale–Short Form (IUS-12), and OCS severity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).ResultsPatients with OCD had significantly higher scores than HCs on all CTQ-33 subscales and on IU measures. In particular, the patient group showed higher IUS-12 total scores than the HC group (39.30 ± 10.42 vs. 32.11 ± 8.62, p < 0.001), with higher prospective anxiety (22.11 ± 5.13 vs. 20.11 ± 4.59, p = 0.009) and inhibitory anxiety scores (17.19 ± 5.99 vs. 12.00 ± 4.82, p < 0.001). Within the patient group, physical abuse was the only CT dimension significantly associated with total Y-BOCS scores (r = 0.248, p = 0.025), whereas IU was positively associated with symptom severity (IUS-12 total: r = 0.346, p = 0.001). Path analysis showed that CT was associated with IU (β = 0.238, p = 0.023), IU was associated with OCS severity (β = 0.329, p = 0.007), and the direct effect of CT on OCS severity was no longer significant after IU was included in the model (c′ = 0.209, p = 0.093), supporting partial mediation.ConclusionCT appears to be elevated in patients with OCD, although its association with symptom severity is not uniform across trauma dimensions. IU may represent an important cognitive mechanism linking CT to OCS severity. These findings suggest that assessing and addressing IU may contribute to more individualized clinical approaches in OCD.