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Krister Westlye Fjermestad

Professor - Klinisk psykologi

Email k.w.fjermestad@psykologi.uio.no

Phone +47 22 84 52 11

Room S02-27

Available hours By agreement

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Visiting address Forskningsveien 3A Harald Schjelderups hus 0373 Oslo

Postal address Postboks 1094 Blindern 0317 Oslo

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Academic interests

Child anxiety disorders, assessment and treatment
Rare disorders
Treatment processes including the alliance

Background

Krister Fjermestad is Dr. Psychol from the University of Bergen in 2012. His PhD is on the alliance in child anxiety treatment. His main areas of research are child anxiety, treatment process, and rare disorders. He is involved in a large randomized controlled trial at Haukeland University Hospital, Bergen, where 182 children were treated for anxiety in community clinics.

He holds a 20% position at Frambu center for rare disorders, involving research and liaison services for families of children with rare disorders.

Fjermestad has worked as a clinical child psychologist in several settings over the last decade, including the child in-patient unit at Haukeland University Hospital.

Partners

He has close international collaborators at Yale University and Virginia Commonwealth University in the US.

Tags: Clinical psychology

Prentice, Caitlin M.; Bondi, Sindre; Juul-Hansen, Simen; Zahl, Erica; Vatne, Torun M. & Fjermestad, Krister (2026). “I Can Relate to That”: Experiences of Families with a Chronic Disorder as Shared by Parents in a Group Setting. Journal for Specialists in Group Work. ISSN 0193-3922. p. 20–20. doi: 10.1080/01933922.2026.2716636. Full text in Research Archive Show summary
This study explores how parents of children with a chronic disorder share their experiences in a group intervention, “SIBS,” delivered in health care services in Norway. Conversations from 10 group sessions with parents (n = 39 parents) were transcribed and analyzed using content analysis. We identified five main themes: 1) sibling knowledge about the disorder, 2) effects on siblings, 3) parenting challenges, 4) concerns about the child with the diagnosis, and 5) community contact. The findings support the group setting as a meaningful arena for parents in families with a chronic disorder to express their experiences to parents in a similar situation.
Prentice, Caitlin Mccombs; Orm, Stian; Kirchhofer, Solveig Melanie; Fredriksen, Trude; Botta, Matteo & Zahl, Erica [Show all 8 contributors for this article] (2026). Family Factors Associated with Teacher-Rated Mental Health for Siblings of Children with Chronic Disorders. School Mental Health. ISSN 1866-2625. doi: 10.1007/s12310-026-09866-2. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at risk of mental health problems, with risk factors including both individual-level characteristics and home-based, family-level factors. Such risk factors tend to inter-correlate, making non-family perspectives, such as those of teachers, an important part of a multi-informant approach to assessing sibling mental health. We investigated whether sibling-, mother- and father-reported family-level factors were associated with teacher-rated mental health of siblings in Norway. We used data from 127 teachers reporting on siblings’ mental health (sibling M age = 10.3 years, SD = 2.0, 53.4% girls, 46.5% boys) to examine associations with familial factors reported by 113 mothers, 85 fathers, and 118 siblings of children with chronic disorders. We found that sibling-reported difficulties with adjustment to living with their brother or sister with a chronic disorder was moderately associated with more teacher-rated internalizing problems for siblings. Lower father-reported family social support was moderately associated with more teacher-rated externalizing problems for siblings. These associations remained significant in multivariate analyses examining all factors simultaneously as predictors of teacher-rated mental health and controlling for sibling age and sex. Emotional and behavioral problems of the child with a chronic disorder, parental mental health, and age difference between the sibling and the child with the disorder were not associated with teacher-rated mental health. Our findings suggest that teachers can detect mental health difficulties in siblings and therefore can be valuable informants on sibling mental health as part of a broader multi-informant approach.
Fjermestad, K.W.; Skjefrås, M. Lahn-Johannessen; Hjelvik, O. & Orm, S. (2026). Coronavirus Fear and Mental Health in Parents of Children with Chronic Disorders: A 12-Month Longitudinal Study. Geopsychiatry. doi: 10.1016/j.geopsy.2026.100079. Full text in Research Archive Show summary
Parents of children with chronic disorders are at increased risk of mental health difficulties. We investigated how coronavirus anxiety and pandemic restrictions affected parental mental health during the COVID 19-pandemic. Parents of children with chronic disorders (N=43) in Norway were followed prospectively for 12 months. Each month, parents completed the Hopkins Symptoms Checklist (SCL-5) as a measure of mental health and the Coronavirus Anxiety Scale (CAS). The stringency index from the Oxford COVID-19 Government Response Tracker was used as a measure of pandemic restrictions. The results showed no change in mental health difficulties or coronavirus anxiety at the group level over the 12 months. At the between-person level, parents with higher level of coronavirus anxiety reported more mental health difficulties (b = .96, p < .001) and an increase in mental health difficulties over the 12 months (b = .05, p = .025). At the within-person level, an increase in coronavirus anxiety from one time to another was associated with an increase in mental health difficulties over that same time (b = .84, p < .001). There was no significant effect of pandemic restrictions in the final model (b = .02, p = .066). We conclude that coronavirus anxiety, but not pandemic restrictions, affected the mental health trajectory of parents of children with chronic disorders during the COVID-19 pandemic. The main implication is that during ongoing or future crises, targeting crisis event-specific anxiety may prevent worsening mental health difficulties among parents of children with chronic disorders.
Prentice, Caitlin Mccombs; Wehrli, Susanne; Zahl, Erica; Orm, Stian; Botta, Matteo & Vatne, Torun Marie [Show all 9 contributors for this article] (2026). Parent–Teacher Discrepancies About the Mental Health of Siblings of Children With Chronic Disorders: A Latent Profile Analysis. Journal of Emotional and Behavioral Disorders. ISSN 1063-4266. 34(2), p. 106–116. doi: 10.1177/10634266261417609. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at an increased risk of internalizing and externalizing problems, but the extent to which this is true varies depending on who rates sibling mental health. We examined interrater discrepancies between teachers and parents who rated the behavior of siblings of children with chronic disorders on the Strengths and Difficulties Questionnaire (SDQ) and investigated possible predictors of these discrepancies. We used Latent Profile Analysis (LPA) to identify classes of siblings with higher and lower levels of discrepancy between raters. Predictors of interrater discrepancy were also examined, including sibling age and sex, and the impact of the disorder. We identified four distinct classes of siblings with differing levels of interrater discrepancy and internalizing and externalizing problems. Sibling sex had a small effect on classes, with girls less likely to be included in the discrepant classes. Neither sibling age nor the impact of the disorder predicted being included in discrepant classes. Our findings reflect previous research showing that sibling experiences and outcomes tend to vary between individuals and across settings and that teachers tend to report fewer problems of different types than parents. Further research is needed to better understand predictors of these interrater discrepancies.
Schumann, Amalie; Vatne, Torun Marie; Dalton, Louise; Rapa, Elizabeth & Fjermestad, Krister Westlye (2025). “It’s like a car that doesn’t like gasoline” - a qualitative study of siblings’ understanding of anorexia nervosa in childhood: perspectives from siblings and parents. Journal of Eating Disorders. 13. doi: 10.1186/s40337-025-01263-5. Full text in Research Archive Show summary
Background When adolescents develop anorexia nervosa (AN), this impacts the family system and puts healthy siblings at risk of mental health problems. Siblings need support and age-appropriate information about the diagnosis to prevent negative mental health outcomes. However, evidence-based support for siblings is limited. The current study aimed to explore siblings’ perceptions of AN and parents’ beliefs about siblings’ understanding expressed within an intervention programme for siblings and parents. Methods This qualitative study employed a hybrid approach, integrating deductive thematic analysis using the common sense model of self-regulation as a coding framework with inductive thematic analysis. The data materials comprised (1) interviews conducted by clinicians with siblings about the AN diagnosis, (2) siblings’ understanding of AN as expressed in sibling groups, (3) parents’ beliefs about what siblings understand expressed in parent groups, and (4) parent-sibling conversations about AN. Video and audio recordings of the data were transcribed and analysed. The sample comprised nine siblings of European descent, aged 8 to 15 years, and their parents. All siblings had a sister with clinically confirmed AN. Results The siblings had limited knowledge and expressed uncertainties about AN across the five themes identity (label and symptoms), causes, consequences, treatment, and timeline. In the inductive analysis, two additional themes were identified. The first, Parental perspectives on siblings’ understanding, had two sub-themes: AN as a confusing and complex disorder, and Discrepancy between siblings’ understanding of AN and parents’ beliefs about their understanding. The second theme was Barriers to communication about the diagnosis. Conclusions The results extend knowledge about informational support needs in siblings of adolescents with AN. Insights into what siblings and parents of adolescents with AN share about the diagnosis in different contexts can be used to guide the adaptation of interventions and policies.
Halsøy, Øyvind; Ebrahimi, Omid Vakili; Johnson, Sverre Urnes; Hoffart, Asle; Moreira, Hugo Cogo & Fjermestad, Krister Westlye (2025). Depressive Symptoms in Individuals With Chronic Conditions During the Covid-19 Pandemic: A 2-Year Longitudinal Study. Stress and Health. ISSN 1532-3005. 41(4). doi: 10.1002/smi.70082. Full text in Research Archive
Smits, Rosanne M.; Aerts, Aukje; Angelov, Teodor; Bentele, Marissa; Blaauw, Ivo de & Dellenmark-Blom, Michaela [Show all 23 contributors for this article] (2025). Addressing psychosocial vulnerability in rare diseases: a call to action from a European expert consensus study. Orphanet Journal of Rare Diseases. 20(1). doi: 10.1186/s13023-025-04017-3. Full text in Research Archive Show summary
Background Persons living with a rare disease (PLWRD) often encounter burdensome and stressful events that may severely affect their psychosocial vulnerability. There is an urgent need for psychosocial support in PLWRD. We aimed to reach consensus about the most prominent psychosocial needs in rare diseases and future research directions to develop adequate psychosocial support for rare diseases. Methods An adapted nominal group technique (NGT) session was conducted in Nijmegen (The Netherlands) with a European expert group of professionals working in the rare disease field. Seventeen participants from seven different European countries took part in the NGT session (seven researchers, two therapists, one patient representative, four clinicians/researchers, and three clinicians), and 23 participants took part in the overall workshop and contributed to this consensus statement. Results An initial list of 57 psychosocial needs was aligned with Pickers’ theoretical framework of eight principles of care: patient-centredness, emotional support, access to care, information and education, partner and family involvement, respect and autonomy, care organisation, continuity of care, and physical comfort. For future research directions, six items remained with main focal points addressing international collaborations, inclusivity in rare diseases (patient representatives, ethnic minorities, and elderly), identifying common needs across rare diseases, and translating psychosocial models from common chronic conditions. Conclusions A consensus meeting was organised that primarily addressed the psychosocial vulnerability in rare diseases. With the outcomes of this study, we aim for better representation of psychosocial vulnerability within health care and to create future research directions to reduce psychosocial vulnerability in rare diseases.
Prentice, Caitlin Mccombs; Aanesen, Anna; Syverstad, Amalie Kirkedelen; Vatne, Torun Marie & Fjermestad, Krister Westlye (2025). Communication quality between parents and siblings of children with chronic disorders. PEC Innovation. 7. doi: 10.1016/j.pecinn.2025.100419. Full text in Research Archive Show summary
Objective This study examines parent-sibling communication during a manual-based group intervention (SIBS) that aims to improve communication quality and well-being for siblings of children with a chronic disorder diagnosis. Methods Audio recordings and transcripts of 20 parent-sibling conversations were analyzed using the manual-based tool Verona Coding Definition of Emotional Sequences (VR-CoDES). We measured siblings' negative expressions and parental responses, focusing on how parents applied the SIBS target behaviours of listening, exploring and validating responses. Results Siblings raised topics such as heritability of the chronic disorder, differential treatment, and instances of violence and temper tantrums. Siblings' negative expressions were 53 % cues (implicit expressions) and 47 % concerns (explicit expressions). Parents provided space in 74 % of the responses to cues and concerns, meaning they gave space for further disclosure. Within these responses, parents applied the SIBS target behaviours, including exploration (59 %), validation (33 %), and listening (8 %). Conclusion Parents mainly provided space and used a warm tone when responding to siblings in the SIBS sessions. Responses included a higher proportion of validation responses and a lower proportion of listening responses compared with previous studies. Innovation Parents and siblings of children with chronic disorders face unique challenges that can negatively impact the quality of parent-sibling communication and psychological adjustment in siblings. This study contributes new insight into how parents and siblings communicate in an intervention setting, and how characteristics of the intervention may influence the quality of this communication.
Kirchhofer, Solveig Melanie; Fredriksen, Trude; Orm, Stian; Botta, Matteo; Zahl, Erica & Moreira, Hugo Cogo [Show all 11 contributors for this article] (2025). Effectiveness of a group intervention to improve mental health in siblings of children with chronic disorders: a cluster randomized controlled trial. Journal of Pediatric Psychology. ISSN 0146-8693. 50(6), p. 443–453. doi: 10.1093/jpepsy/jsaf021. Full text in Research Archive Show summary
Objective: We evaluated the effectiveness of SIBS, a preventive intervention for siblings and parents of children with chronic disorders (CDs). Methods: This two-arm, unmasked cluster randomized controlled trial registered on ClinicalTrials.gov (NCT04056884), included 288 siblings (M age ¼ 10.4 years, SD ¼ 1.9) and parents of children with CDs (mainly neurodevelopmental disorders) randomly assigned to intervention (k ¼ 34, n ¼ 137) or waitlist control (k ¼ 35, n ¼ 151) groups. Eligible siblings were aged 8–16 years and had a sibling diagnosed with a CD. SIBS is manual-based and was delivered as five sessions over 2 weeks in primary care and hospital settings across Norway. Three sessions are separate for siblings and parents, and two are integrated sibling–parent dialogues. The primary outcome was sibling mental health, rated by siblings, parents, and teachers. The secondary outcome was parent–child communication, rated by siblings and parents. Analyses included intention-totreat (ITT) and complier average causal effects (CACE). Results: Although not statistically significant, at 3-month follow-up, the intervention group showed fewer mental health problems (ITT: siblingrated d ¼ −0.16, 95% CI [−0.49, 0.17]; parent-rated d ¼ −0.10, 95% CI [−0.48, 0.12]; teacher-rated d ¼ −0.18, 95% CI [−0.50, 0.29]) and higherquality parent–child communication (ITT: sibling-rated d ¼ 0.21, 95% CI [−0.10, 0.52]; parent-rated d ¼ 0.24, 95% CI [−0.07, 0.55]) compared to waitlist. Conclusions: The SIBS intervention demonstrated small, consistent positive effects on sibling mental health and parent–child communication. This suggests SIBS is a promising preventive program for siblings of children with CDs. Keywords: siblings, parents, intervention, prevention, randomized controlled trial.
Fredriksen, Trude; Orm, Stian; Prentice, Caitlin Mccombs; Kirchhofer, Solveig Melanie; Zahl, Erica & Botta, Matteo [Show all 8 contributors for this article] (2025). Disorder Type and Severity as Predictors of Mental Health in Siblings of Children with Chronic Disorders. Journal of Autism and Developmental Disorders. ISSN 0162-3257. doi: 10.1007/s10803-025-06771-6. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at risk of developing mental health problems. Studies are inconclusive about whether sibling mental health is best predicted by the specific diagnoses of the child with disorder or by transdiagnostic factors. The aims of the present study were (1) to examine if specific diagnoses predicted sibling mental health, and (2) to examine if disorder severity in the child with the chronic disorder predicted sibling mental health. Baseline data from a randomized controlled trial were used. Siblings (aged 8 – 16 years) of children with chronic disorders and their parents were recruited from eight municipality and hospital clinics (N = 288). The children with chronic disorders were placed in ICD-10 diagnostic categories based on combined parent report and clinical records. Regression analyses with the most frequent primary diagnoses (ADHD, Asperger syndrome, autism, down syndrome, rare disorders) and a measure of disorder severity as predictors of sibling mental health were run. Father-reported disorder severity predicted sibling-reported internalizing problems and father-reported internalizing and externalizing problems in siblings. Mother-reported disorder severity predicted mother-reported sibling internalizing problems. No single primary diagnosis predicted sibling internalizing or externalizing problems. Disorder severity does to an extent predict sibling mental health, whereas single diagnostic categories do not. Disorder severity may be used to identify siblings at risk and/or in need of interventions. Fathers should be included in assessment and health care for siblings as their reports seem to predict sibling mental health better than the mothers.
Orm, Stian; Wood, Jeffrey J.; Fossum, Ingrid Nesdal; Adams, Keenan; Andersen, Per Normann & Fjermestad, Krister Westlye [Show all 8 contributors for this article] (2025). Anxiety Symptoms Predict Subsequent Depressive Symptoms in Neurodivergent Youth: A 10-Year Longitudinal Study. Research on Child and Adolescent Psychopathology. ISSN 2730-7166. 53(3), p. 429–441. doi: 10.1007/s10802-025-01292-3. Full text in Research Archive Show summary
Neurodivergent youth often experience anxiety and depressive symptoms that may hamper adaptive functioning and well-being. There is little knowledge of how anxiety and depression are related in neurodivergent youth. Therefore, we aimed to examine whether the relationship between anxiety and depressive symptoms is uni- or bidirectional in neurodiverse youth. We assessed self-reported anxiety and depressive symptoms over time in 173 youth (Mbaseline age = 11.7 years, SD = 2.1, 64% males, 36% females). The sample comprised 38 autistic youth, 85 youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 50 comparison youth assessed at baseline (T1), 2-year follow-up (T2, 97% retention), and 10-year follow-up (T3, 73% retention). We used cross-lagged models to analyze the data. In neurodivergent youth, more anxiety symptoms at T1 and T2 predicted more depressive symptoms at T2 and T3. Preceding anxiety symptoms were linked with later depressive symptoms, even after accounting for autoregressive effects of depressive symptoms. The results are consistent with a prodromal model in which anxiety symptoms can independently foreshadow the emergence of depressive symptoms over the course of development among neurodivergent youth. Potentially, addressing anxiety symptoms among youth with autism or ADHD could play a role in preventing the onset of youth depression.
Kirchhofer, Solveig Melanie; Orm, Stian; Briggs, Nancy E.; Fredriksen, Trude; Zahl, Erica & Prentice, Caitlin Mccombs [Show all 11 contributors for this article] (2025). Siblings in families of children with chronic disorders: a model of risk and protective factors. Journal of Pediatric Psychology. ISSN 0146-8693. 50(6), p. 488–499. doi: 10.1093/jpepsy/jsaf017. Full text in Research Archive Show summary
Objective We empirically tested a family systems model’s ability to explain variance in psychosocial adjustment among siblings of children with chronic developmental and physical disorders (CDs). The model included the impact of CD severity, family social support, parental mental health, and parent–sibling communication quality. We hypothesized that family social support would moderate the relationship between CD severity and parent mental health, and that sibling-reported communication quality with their parents would mediate the relationship between parent mental health and sibling psychosocial adjustment. Methods We used baseline data from a sibling intervention trial (SIBS-RCT) comprising 288 families with siblings aged 8–16 years and their parents, recruited from health services and user organizations. Parents reported CD severity, parental mental health, and family social support. Siblings self-reported their psychosocial adjustment, including mental health, CD-related adjustment, quality of life, and prosocial behavior. We employed structural equation modeling to test the hypothesized relationships. Results Higher parent–sibling communication quality was significantly associated with better sibling-reported quality of life and more prosocial behavior. Lower levels of paternal depression were significantly associated with better sibling-reported quality of life and mental health, whereas maternal depression was not. We did not find support for the hypothesized mediating and moderating pathways for family social support and parent–sibling communication. Conclusions The findings highlight the importance of addressing paternal mental health and parent–sibling communication in promoting sibling psychosocial adjustment. Future studies should use comprehensive, multi-informant approaches and consider the complex interplay of family factors in the context of childhood CD.
Fjermestad, Krister Westlye & Lervik, Nora Hjelde (2025). “His brain works in a different way”: siblings’ understanding of autism. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1506057. Full text in Research Archive
Halsøy, Øyvind; Orm, Stian; Moreira, Hugo Cogo; Silverman, Wendy K. & Fjermestad, Krister Westlye (2025). Trajectories of depression and anxiety in adults with rare disorders across 13 months during the COVID-19 pandemic. Orphanet Journal of Rare Diseases. 20(1). doi: 10.1186/s13023-025-03633-3. Full text in Research Archive Show summary
Background: Adults with rare disorders experience multiple psychosocial risk factors beyond their medical symptoms, including impaired quality of life, social isolation, loneliness, and mental health problems. These risk factors were amplified during the COVID-19 pandemic, when health care appointments and social/vocational activities were reduced or cancelled. There is a lack of longitudinal data tracking this population over time, making the long term consequences uncertain. Methods: We conducted a monthly survey of 58 adults aged between 19 and 71 years (M = 45.1 years, SD = 12.6) with rare disorders across 13 months during the COVID-19 pandemic in Norway. We measured symptoms of anxiety and depression with the Hopkins Symptom Checklist-5. Covid fear was measured with the Coronavirus Anxiety Scale. We examined the mental health and covid fear trajectories across the 13 months with multi-level growth curve models with repeated measures at Level 1 and individuals at Level 2. To account for differences in governmental restrictions throughout the 13 months, we used the stringency index from The Oxford Covid-19 Government Response Tracker. Results: The growth models indicated stable levels of anxiety and depression over 13 months that were elevated compared to existing population data and were unpredicted by pandemic restrictions. The level of covid fear was significantly associated with the levels of anxious and depressive symptoms. Conclusions: The current study found elevated and stable trajectories of mental health symptoms throughout the pandemic for persons with rare disorders. This highlights the necessity of investigating the long-lasting influence of the pandemic on mental health among individuals with rare disorders.
Prentice, Caitlin Mccombs; Fjermestad, Krister Westlye; Haukeland, Yngvild Bjartveit & Vatne, Torun Marie (2025). Psychosocial Functioning for Preschool-Aged Siblings of Children With Chronic Disorders: A Scoping Review. Child: Care, Health and Development. ISSN 0305-1862. 51(2). doi: 10.1111/cch.70039. Full text in Research Archive
Zahl, Erica; Willemen, Agnes M.; Fredriksen, Trude; Kirchhofer, Solveig Melanie; Vatne, Torun Marie & Orm, Stian [Show all 9 contributors for this article] (2024). Mental health in mothers and fathers of children with chronic disorders. PEC Innovation. 5. doi: 10.1016/j.pecinn.2024.100331. Full text in Research Archive Show summary
Objective This study applied the Family Systems Illness Model to examine how child disorder severity influences mental health in mothers and fathers of children with chronic (mainly developmental) disorders (CD). Methods We measured parental mental health and perceived child disorder severity among 204 mothers and 125 fathers of 220 children with CD and compared the mental health scores with norms. We analyzed how much of the variance in parental mental health was explained by child disorder severity, including discrepancy between maternally and paternally perceived severity. Results Compared to norms, we found elevated mental health problems in both mothers (d = 0.45) and fathers (d = 0.20) of children with CD. Mothers had higher scores than fathers on both mental health problems (d = 0.63) and severity (d = 0.43). Perceived disorder severity was similarly associated with mental health problems for mothers (β = 0.23) and fathers (β = 0.34). Discrepancy between maternal and paternal perceived disorder sever
Fjermestad, Krister Westlye; Norum, Fredrik Ø.; Brask, Helene S.; Kodal, Arne; Silverman, Wendy K. & Heiervang, Einar Røshol [Show all 7 contributors for this article] (2024). Anxiety Symptom Trajectories Predict Depression Symptom Trajectories up to Four Years After CBT for Youth Anxiety Disorders. Research on Child and Adolescent Psychopathology. ISSN 2730-7166. 52, p. 1–11. doi: 10.1007/s10802-024-01214-9. Full text in Research Archive Show summary
Long-term data on depression symptoms after cognitive behavioral therapy (CBT) for youth anxiety disorders are scant. We examined depression symptoms up to four years post CBT for anxiety addressing youth age and gender, family social class, and parent mental health as predictors. The sample comprised 179 youth (M age at pre-treatment = 11.5 years; SD = 2.1) in a randomized controlled trial. Clinically assessed anxiety diagnoses and youth and parent-reported anxiety and depression symptoms were measured before, after, and one and four years after CBT. Parent self-reported mental health was measured before CBT. We used regression analyses to determine whether full diagnostic recovery at post-CBT predicted depression trajectories across the four-year assessment period. We used growth curve models to determine whether anxiety trajectories predicted depression trajectories across the four-year assessment period. Youth who lost their anxiety diagnoses after CBT had significantly lower parent-reported depression le
Lønning, Ingvild Synnøve; Fjermestad, Krister Westlye & Haugland, Bente Storm Mowatt (2024). Mental Health and Well-being in Adolescent and Adult Siblings of Persons with Severe Mental Illness: A Scoping review. Journal of Child and Family Studies. ISSN 1062-1024. 33, p. 1934–1948. doi: 10.1007/s10826-023-02759-x. Full text in Research Archive Show summary
Systematic knowledge about siblings of persons with mental illness is needed. The aim of this literature review was to gain knowledge about the mental health and well-being of siblings of individuals with severe mental illness (i.e., bipolar disorder, schizophrenia, eating disorders, psychosis) and factors associated with sibling outcomes. We reviewed quantitative studies published between 1990 and 2022 where siblings aged >12 years were compared to healthy control individuals. Eleven studies were included (combined sibling n = 1736). Seven of the 11 studies reported solely more negative outcomes for siblings than for healthy control individuals. Two studies reported both more negative and more positive sibling outcomes, with one study reported solely more positive outcomes and one no difference between siblings and healthy control individuals. The studies reporting negative outcomes had the highest methodological quality. The following factors were associated with sibling outcomes; demographic factors, i.e., age, sex, and number of siblings in the family, contextual factors, i.e., having contact with health care professionals due to own mental health problems, and characteristics of the sibling with severe mental illness, i.e., premorbid adjustment. The findings show that a family system approach with interventions addressing the entire family is indicated when a person is treated for severe mental illness. Further research on sibling outcomes should address methodological challenges such as poor representativeness and a wide age range in samples and use well-validated outcome measures. Factors associated with sibling outcomes should be examined further to increase the understanding of risk and protective factors in siblings.
Zahl, Erica; Moreira, Hugo Cogo; Fredriksen, Trude; Kirchhofer, Solveig Melanie; Orm, Stian & Vatne, Torun Marie [Show all 8 contributors for this article] (2024). Mental health dynamics between mothers and siblings of children with disabilities. Frontiers in Psychology. 15. doi: 10.3389/fpsyg.2024.1501343. Full text in Research Archive Show summary
Introduction: When a child has a disability, their families face significant challenges that also impact parents' and siblings' mental health and adjustment. We examined the potential bidirectional relationships between parental mental health and sibling mental health and adjustment in families of children with a disability. Methods: We utilized baseline and 12-month follow-up data from a randomized controlled trial of a brief intervention designed to enhance parent-sibling communication in families of children with a disability. The sample comprised 214 siblings aged 8-16 years and their parents (N = 203 mothers, N = 124 fathers). We estimated bivariate latent change score models to examine the longitudinal cross-domain associations between changes in parental mental health and changes in sibling mental health, and changes in parental mental health and sibling adjustment. Results: The results showed that changes in maternal mental health and sibling adjustment over the 12-month period were correlated (r =
Bertie, Lizel-Antoinette; Quiroz, Juan C.; Berkovsky, Shlomo; Arendt, Kristian; Bögels, Susan & Coleman, Jonathan R.I. [Show all 30 contributors for this article] (2024). Predicting remission following CBT for childhood anxiety disorders: a machine learning approach. Psychological Medicine. ISSN 0033-2917. doi: 10.1017/S0033291724002654. Full text in Research Archive
Boettcher, Johannes; Orm, Stian & Fjermestad, Krister Westlye (2024). Autism traits, social withdrawal, and behavioral and emotional problems in a Norwegian cohort of adolescents with rare genetic disorders. Research in Developmental Disabilities. ISSN 0891-4222. 147. doi: 10.1016/j.ridd.2024.104699. Full text in Research Archive Show summary
Background: Adolescents with rare genetic disorders represent a population that can be at risk in psychosocial terms. Despite its importance, the association of autism traits and social withdrawal in behavioral and emotional problems in adolescents with rare genetic disorders remains understudied. Aim: The study aimed to empirically examine the clinical characteristics of adolescents with rare genetic disorders with a behavior theory-driven approach. Method: We investigated the behavioral and emotional problems and current and lifetime autistic traits in a sample of 93 Norwegian adolescents (Mage = 13.2 years, SDage = 2.4, rangeage 10–17, 62.4% females, 37.6% males) with various rare genetic disorders. The adolescents were investigated cross-sectionally utilizing standardized psychometric questionnaires rated by their parents. Results: More current and lifetime autistic traits and social withdrawal were all associated with more internalizing problems. Further analyses demonstrated that social withdrawal partially mediated the positive association between current autistic traits and internalizing problems. In contrast, social withdrawal fully mediated the positive association between lifetime autistic traits and internalizing problems. Conclusion and implications: Our results demonstrate important characteristics of adolescents with rare genetic disorders that may guide clinicians and future interventions. Social withdrawal may be prodromal to internalizing problems such as anxiety and depression. Thus, clinically addressing social withdrawal can represent a means to prevent internalizing problems in adolescents with rare genetic disorders and autistic traits.
Fredriksen, Trude; Vatne, Torun Marie; Haukeland, Yngvild Bjartveit; Czajkowski, Nikolai Olavi; Wakefield, Claire E. & Fjermestad, Krister Westlye (2024). Evaluation of Siblings’ Perceived Relationship Outcomes with Their Parents in an Open Trial of the SIBS Intervention for Children with Chronic Disorders. Journal of Child and Family Studies. ISSN 1062-1024. 33. doi: 10.1007/s10826-024-02824-z. Full text in Research Archive Show summary
The SIBS intervention aims to prevent mental health problems for siblings of children with chronic disorders and has shown promising results. The mechanisms behind these changes have not been examined. Parent-child relationship quality is a predictor of mental health in siblings. Our first objective was to investigate whether sibling-perceived relationship quality between siblings and parents changes over time after participating in SIBS. Second, as the intervention requires participation of only one parent, we examined with a dual scale (anxiety and avoidance attachment style) whether relationship quality was associated with which parent participated. Third, as SIBS aims to promote parents‘ communication skills, we examined whether sibling-perceived communication quality with parents predicted relationship quality over time. The sample comprised 99 siblings (M = 11.5 years, SD = 2.0; range 8–16; 54% girls, 46% boys) of children with chronic disorders and one parent per sibling (63% mothers). We administered the questionnaires at pre-intervention, at three- and 6-months postintervention. We applied growth curve models for relationship quality over time with communication quality as a predictor, controlling for parent gender. We found significant improvement in sibling-perceived relationship quality with the participating and the non-participating parent on the relationship anxiety scale over time, with small to medium effect sizes. Higher communication quality significantly predicted improvement of relationship quality in all four relationship outcomes. We conclude that change in relationship quality may be part of the positive outcomes of the SIBS intervention and is mainly explained by communication enhancement. Controlled trials of the SIBS intervention are indicated.
Tien, Ingrid S.; Orm, Stian; Wood, Jeffrey J.; Skogli, Erik Winther & Fjermestad, Krister Westlye (2024). Sex Differences in Autism Symptoms and Mental Health Difficulties in Adolescents with Rare Genetic Disorders. Advances in Neurodevelopmental Disorders. ISSN 2366-7532. doi: 10.1007/s41252-024-00405-1. Full text in Research Archive Show summary
Objectives Adolescents with rare genetic disorders often display autism traits and mental health difficulties. Sex differences have been identified for mental health symptoms, including comorbidity with autism difficulties, among autistic youth. However, these sex differences may differ with rare genetic ethology and have yet to be examined in rare genetic disorders. Therefore, the aim of this study was to examine sex differences in mental health difficulties and autism symptoms among adolescents with rare genetic disorders. Method Adolescents with rare genetic disorders (N = 93 Mage = 13.2 years, SD = 2.4, 60.2% females, 39.8% males) were assessed with parent-reports on the Child Behavior Checklist, the Social Communication Questionnaire, and the Social Responsiveness Scale. Results Males displayed more total autism characteristics and externalizing difficulties compared with females (Hedges g = 0.44-0.71). Within autism subdomains, males displayed more restrictive and repetitive behaviors and social communication difficulties compared with females (Hedges g = 0.43-0.63). In examining interaction effects, females were found to have a stronger relationship between restrictive and repetitive behaviors and total mental health and externalizing behaviors than males on the Social Communication Questionnaire. Conclusions The sex differences typically found with idiopathic autism could be extended to a sample of adolescents with a known genetic likelihood of autism traits. Among adolescents with rare genetic conditions, autism symptoms may be more strongly associated with mental health difficulties in females compared with males.
Zahl, Erica; Dale, Sigurd Skjeggestad; Fjermestad, Krister Westlye & Vatne, Torun Marie (2024). Parenting a child with a disability: Fathers’ perceptions of the couple relationship. Journal of Social and Personal Relationships. ISSN 0265-4075. doi: 10.1177/02654075241248387. Full text in Research Archive
Veerman, Linda K.M.; Orm, Stian; Fjermestad, Krister Westlye; Vatne, Torun Marie; Haukeland, Yngvild Bjartveit & Sterkenburg, Paula S. [Show all 7 contributors for this article] (2024). Measuring adjustment of siblings of children with disabilities: psychometric properties across translations, age groups and informants. International Journal of Developmental Disabilities (IJDD). ISSN 2047-3869. doi: 10.1080/20473869.2024.2411511. Full text in Research Archive
Orm, Stian; Tien, Ingrid S.; Wood, Jeffrey J. & Fjermestad, Krister Westlye (2024). Autism and attention-deficit/hyperactivity symptoms as risk factors of school attendance problems in youth with rare genetic disorders. Discover Psychology. 4(1). doi: 10.1007/s44202-024-00303-6. Full text in Research Archive Show summary
Background School attendance problems are common among youth with autism spectrum disorder (ASD) or attention defcit/hyperactivity disorder (ADHD). We investigated the role of ASD and ADHD symptoms in school attendance problems among youth with rare genetic disorders, which are present in fewer than 1 in 2000 people. Method Parents completed the Social Responsiveness Scale (SRS) and the Child Behavior Checklist (CBCL) about their youth with a rare genetic disorder (N=93; Mage=13.2 years, SD=2.3, 62.4% females, 37.6% males). School attendance problems were assessed with the CBCL school anxiety and truancy items. The data were analyzed using generalized linear mixed models. Results One-fourth of the sample (27%) displayed school anxiety, and 11% displayed truancy. More ASD symptoms (OR=1.04, 95% CI [1.02, 1.06]) and ADHD symptoms (OR=1.22, 95% CI [1.07, 1.38]) were associated with a higher risk of school anxiety. The analyses indicated that the associations between ASD and ADHD symptoms and school anxiety could be accounted for by internalizing symptoms. Externalizing symptoms were associated with truancy. There was no relationship between ASD/ADHD symptoms and truancy. Conclusions More ASD and ADHD symptoms in youth with rare genetic disorders are associated with an increased risk of being afraid of school, but not truancy. The risk entangled by ASD and ADHD symptoms can be accounted for by the commonly co-occurring internalizing symptoms. Assessment of ASD and ADHD symptomatology in youth with rare genetic disorders may be important to target educational and psychosocial support and prevent school attendance problems.
Orm, Stian; Wood, Jeffrey J.; Fossum, Ingrid Nesdal; Andersen, Per Normann; Fjermestad, Krister Westlye & Øie, Merete Glenne [Show all 7 contributors for this article] (2024). Within-Person Effects of Executive Functioning on Anxiety and Depressive Symptoms in Youth with Neurodevelopmental Disorders: A Longitudinal Study. Advances in Neurodevelopmental Disorders. ISSN 2366-7532. doi: 10.1007/s41252-024-00421-1. Full text in Research Archive Show summary
Objectives The objective was to disentangle the role of between- and within-person variation in executive functioning (EF) in the development of anxiety and depressive symptoms among youth with neurodevelopmental disorders. Methods We assessed 85 youth with ADHD, 38 youth with autism spectrum disorder (ASD), and 50 typically developing (TD) youth at baseline (Mage = 11.7 years, 64% males), 2-year follow-up, and 10-year follow-up with neuropsychological tests of EF and anxiety and depressive symptoms scales. Results Across groups, depressive symptoms increased with age, whereas anxiety symptoms were stable. Greater within-person improvement in overall EF from baseline to 2-year follow-up predicted reduced anxiety symptoms. Greater within-person improvement in cognitive flexibility predicted reduced depressive symptoms from baseline to 2-year follow-up. Conclusions We conclude that improvement in EF skills in youth may lessen the severity of anxiety and depressive symptoms over time. Thus, EF could be an intervention target to prevent anxiety and depressive symptoms.
Skumsnes, Toril; Fjermestad, Krister Westlye; Wergeland, Gro Janne Henningsen; Aalberg, Marianne; Heiervang, Einar Røshol & Kodal, Arne [Show all 7 contributors for this article] (2024). Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Research on Child and Adolescent Psychopathology. ISSN 2730-7166. 52, p. 1427–1439. doi: 10.1007/s10802-024-01215-8. Full text in Research Archive Show summary
The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N=179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.
Huster, Rene Jürgen; Thunberg, Christina; Solbakk, Anne-Kristin; Gravholt, Claus H. & Fjermestad, Krister Westlye (2024). Inhibitory deficits in Klinefelter syndrome are secondary to deficits in the auditory and motor domain. NeuroImage: Clinical. 44. doi: 10.1016/j.nicl.2024.103674. Full text in Research Archive
Prentice, Caitlin Mccombs; Orm, Stian; Botta, Matteo; Vatne, Torun Marie; Fredriksen, Trude & Kirchhofer, Solveig Melanie [Show all 7 contributors for this article] (2024). Teacher-Rated Mental Health of Siblings of Children with Chronic Disorders. School Mental Health. ISSN 1866-2625. 16, p. 1183–1196. doi: 10.1007/s12310-024-09685-3. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at a heightened risk for internalizing and externalizing problems. Studies on sibling mental health typically use parent report, and sometimes sibling self-report, but do not include the perspectives of teachers. We investigated how teachers and parents in Norway rated sibling mental health to gain a more coherent picture of siblings’ well-being and functioning across the home and school contexts. We compared how siblings aged 8–16 years (45% boys, 54% girls) were scored on the strengths and difficulties questionnaire by teachers (n = 125), mothers (n = 115), and fathers (n = 81) with population norms and clinical cutoffs. For boys, the mean teacher scores did not indicate problems for total difficulties or any subscale except hyperactivity–inattention, but mean parent scores were higher for total difficulties and most subscales (d = .44 to .96). For girls, teachers indicated higher than norm scores for total difficulties, emotional problems, hyperactivity–inattention and peer problems (d = .26 to .46), while parents indicated higher total difficulties and problems across most subscales (d = .31 to .54). Prosocial behavior was as a relative strength of siblings across all raters. Siblings may not display the same level of mental health problems in school as at home, and teachers can offer an important perspective on siblings’ mental health and functioning.
Schumann, Amalie; Vatne, Torun Marie & Fjermestad, Krister Westlye (2024). What challenges do siblings of children with chronic disorders express to their parents? A thematic analysis of 73 sibling-parent dialogues. Journal of Pediatric Nursing : Nursing Care of Children and Families. ISSN 0882-5963. 76, p. 91–98. doi: 10.1016/j.pedn.2024.01.032. Full text in Research Archive
Fjermestad, Krister Westlye; Wallin, Malin Haggkvist; Naujokat, Frederike; McLeod, Bryce D.; Silverman, Wendy K. & Öst, Lars-Göran [Show all 9 contributors for this article] (2024). Group cohesion and alliance predict cognitive-behavioral group treatment outcomes for youth with anxiety disorders. Cognitive Behaviour Therapy. ISSN 1650-6073. 54(1), p. 96–114. doi: 10.1080/16506073.2024.2385906. Full text in Research Archive Show summary
Knowledge about how to enhance group cognitive behavioral therapy (GCBT) outcomes is needed. In a randomized controlled effectiveness trial, we examined group cohesion (the bond between group members) and the alliance (the client-clinician bond) as predictors of GCBT outcomes. The sample was 88 youth (M age 11.7 years, SD = 2.1; 54.5% girls; 90.7% White) with anxiety disorders. Observers rated group cohesion and alliance in 32 sessions from 16 groups. We examined early group cohesion and alliance (r = .50, p
Fjermestad, Krister Westlye; Naujokat, Frederike; Wallin, Malin Haggkvist & Wergeland, Gro Janne Henningsen (2024). Mediation Effects of Group Cohesion in Group-Based Cognitive Behavioral Therapy for Youth Anxiety Disorders. International journal of group psychotherapy. ISSN 0020-7284. doi: 10.1080/00207284.2024.2365718. Full text in Research Archive
Wergeland, Gro Janne Henningsen; Ghaderi, Ata; Fjermestad, Krister Westlye; Enebrink, Pia; Halsaa, Lillan & Njardvik, Urdur [Show all 9 contributors for this article] (2024). Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-024-02544-1. Full text in Research Archive Show summary
Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.PROSPERO [CRD42023441794].
Fjermestad, Krister Westlye; Orm, Stian; Fredriksen, Trude; Haukeland, Yngvild Bjartveit & Vatne, Torun Marie (2024). Factor Structure of the Experiences in Close Relationships—Relationship Structures Scale (ECR-RS) in Siblings of Children with Chronic Disorders. Children. 11(5), p. 1–11. doi: 10.3390/children11050560. Full text in Research Archive Show summary
Our objective was to examine the factor structure of the Experiences in Close Relationships-Relationships Structures (ECR-RS), an attachment-theory based relationship measure, in at-risk sample comprising siblings of children with chronic disorders. Psychometric studies with general populations have demonstrated that the ECR-RS comprises two factors, representing anxiety and avoidance in close relationships. The sample comprised 103 siblings (M age = 11.5 years, SD = 2.2, range 8 to 16 years) of children with chronic disorders and their parents. The siblings completed a 9-item version of the Experiences in Close Relationships-Relationships Structures (ECR-RS) about their relations with mothers and fathers that was analyzed with confirmatory factor analysis. We examined construct validity using correlations between sibling social functioning, measured with the Strengths and Difficulties Questionnaire, and parent mental health, measured with the Hopkins Symptom Checklist-90-Revised. The ECR-RS comprised two factors, anxiety and avoidance, in line with previous studies. Both factors demonstrated significant overlap with sibling social functioning, but not with parental mental health. We conclude that the ECR-RS comprises two factors, anxiety and avoidance, that are related to siblings' social functioning. The ECR-RS can be used as a psychometrically sound measure of relationship anxiety and avoidance in families of children with chronic disorders.
Veerman, Linda K.M.; Fjermestad, Krister Westlye; Vatne, Torun Marie; Sterkenburg, Paula S.; Derks, Suzanne D.M. & Dijken, Anjet A.J. Brouwer-van [Show all 7 contributors for this article] (2024). Cultural applicability and desirability of ‘Broodles’: The first serious game intervention for siblings of children with disabilities. PEC Innovation. 4. doi: 10.1016/j.pecinn.2024.100277. Full text in Research Archive
Orm, Stian; Blikstad-Blumenthal, Celina & Fjermestad, Krister Westlye (2023). Attitudes toward people with intellectual disabilities in Norway. International Journal of Developmental Disabilities (IJDD). ISSN 2047-3869. doi: 10.1080/20473869.2023.2230825. Full text in Research Archive Show summary
Background We investigated attitudes toward individuals with an intellectual disability (ID) in a Norwegian sample and tested the psychometric properties of a Norwegian translation of the Community Living Attitudes Scale – Intellectual Disability (CLAS-ID). Method The sample was 645 adults (M = 41.9 years, SD = 13.8, 80% female). One subgroup had working experience with individuals with an ID (n = 377), and another subgroup had a family member with an ID (n = 133). Results The four-factor structure of the CLAS-ID showed good model fit in a confirmatory factor analysis of the Norwegian translation with adequate internal consistency. Participants with working experience with ID or a family member with ID reported more favorable attitudes compared with participants without working experience or without a family member with ID, respectively. Women and older participants reported more positive attitudes compared to men and younger participants. Conclusion The Norwegian translation of the CLAS-ID appears to be a valid tool for assessing attitudes toward individuals with an ID. Individuals with first-hand experience with individuals with an ID have more positive attitudes than those without, and women and older people have more positive attitudes than men and younger people.
Fjermestad, Krister Westlye; Bergh, Nathalie; Fleten, Susanne Kyte; Huster, Rene Jürgen; Gravholt, C. & Solbakk, Anne-Kristin (2023). Mentalization and cognitive skills in men with Klinefelter syndrome versus non-clinical controls. Psychiatry Research Communications. 3(2). doi: 10.1016/j.psycom.2023.100116. Full text in Research Archive Show summary
We investigated cognition and mentalization skills, defined as the ability to understand one's own and others' intentions and emotions, in men with Klinefelter Syndrome (KS). The sample was 26 men with KS and 26 non-clinical male controls aged 19–65 years. We measured mentalization with the Reading the Mind in the Eyes Test (RMET) and cognition with neuropsychological tests. The results showed that men with KS had significantly lower scores on the RMET compared to controls. However, the group difference was not significant when controlling for IQ. There were more significant correlations between cognitive domains and mentalization skills in the KS group than for controls. In regression models, cognitive domains explained up to 54% of the variance in mentalization skills for men with KS, compared to 15% for controls. The men with KS struggled particularly with interpreting neutral and negative emotional states relative to the control group. We conclude that men with KS exhibit mentalization difficulties, which are strongly linked to their cognitive abilities, and especially their deficits in verbal learning. Interventions aimed at enhancing language and other neuropsychological functions, as well as mentalization skills, are warranted.
Fjermestad, Krister Westlye; Finnbakk, R.R.; Solbakk, Anne-Kristin; Gravholt, C.H. & Huster, Rene Jürgen (2023). Subjective versus objective sleep in men with Klinefelter syndrome. Orphanet Journal of Rare Diseases. 18(1). doi: 10.1186/s13023-023-02822-2. Full text in Research Archive Show summary
Objectives To investigate sleep among men with Klinefelter syndrome (KS). Method We compared the sleep domains latency, disturbance, and efficiency in 30 men with KS (M age = 36.7 years, SD = 10.6) to 21 age-matched non-KS controls (M age = 36.8 years, SD = 14.4). Actigraphs were used to objectively measure sleep across 7 days and nights. Participants also completed a sleep diary over the same period, and the Pittsburgh Sleep Quality Index (PSQI). Results The mean correlation between the objective and subjective sleep measures was lower for the KS sample (M r = .15) than for controls (M r = .34). Sleep disturbance was significantly larger in the KS sample, as measured by actigraphy (p = .022, d = 0.71) and the PSQI (p = .037, d = 0.61). In regression models predicting sleep domains from KS status, age, educational level, vocational status, IQ, and mental health, KS status was not a significant predictor. Higher age was associated with more actigraphy-measured sleep disturbance. Higher educational level and being employed were associated with better sleep efficiency. Conclusions Sleep disturbance may be a particular problem for men with KS and should be measured with complimentary methods.
Orm, Stian; Øie, Merete Glenne; Fossum, Ingrid Nesdal; Fjermestad, Krister Westlye; Andersen, Per Normann & Skogli, Erik Winther (2023). Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study. Journal of Attention Disorders. ISSN 1087-0547. 27(5), p. 458–469. doi: 10.1177/10870547231153962. Full text in Research Archive Show summary
Objective: We tested the hypotheses that (1) a diagnosis of ADHD in childhood or adolescence is associated with reduced quality of life (QoL) and everyday functioning in emerging adulthood, and (2) executive function (EF) deficits, internalizing difficulties, and ADHD symptoms predict reduced QoL and more functional impairments. Method: We assessed 85 children and adolescents with ADHD and 50 typically developing (TD) peers at baseline (Mage = 11.6 years, 58% males), 2-year follow-up, and 10-year follow-up with neuropsychological tests of EF and self-reports. Results: Individuals with ADHD reported lower QoL and functional impairments in emerging adulthood compared to TD peers. More internalizing difficulties and ADHD symptoms at baseline and 2-year follow-up significantly predicted lower QoL and more functional impairments at the 10-year follow-up. Conclusion: ADHD and internalizing difficulties in childhood or adolescence have a negative impact on QoL and everyday functioning in emerging adulthood. Keywords: ADHD; anxiety; depression; executive function; functional impairments; longitudinal; quality of life.
Dyresen, Agnete; Stubberud, Jan Egil; Fjermestad, Krister Westlye; Haugen, Ingvild & Øie, Merete Glenne (2023). Executive control training for adolescents with ADHD: Study protocol for a randomized controlled trial. Contemporary Clinical Trials. ISSN 1551-7144. 136. doi: 10.1016/j.cct.2023.107404. Full text in Research Archive Show summary
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD. Methods: This pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment. Conclusion: The study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.
Rognli, Erling Wright & Fjermestad, Krister Westlye (2023). Informant Discrepancy in Report of Parent-adolescent Conflict as a Predictor of Hopelessness among Depressed Adolescents: A Replication Study. Journal of Child and Family Studies. ISSN 1062-1024. 32, p. 2522–2531. doi: 10.1007/s10826-023-02610-3. Full text in Research Archive Show summary
More knowledge is needed about how family factors influence depression features in adolescents. We aimed to replicate a previous small sample study showing that higher discrepancy between adolescents and caregivers in report of conflict predicted more hopelessness in adolescents with major depression. The current sample comprised 417 adolescent and maternal caregiver dyads. The adolescents were aged between 12 and 17 years (55.4% female, 44.6% male). The sample was drawn from the Treatment of Adolescents with Depression Study (TADS). Analyses were conducted using latent difference score modelling, item response theory, and linear regression in a Bayesian framework. Higher adolescent-perceived conflict relative to caregiver-perceived conflict predicted more adolescent hopelessness. This replicated the original findings in a much larger sample. Adolescent gender did not influence the associations. Addressing divergence in adolescent and parent perceptions of conflict may be relevant to ameliorate hopelessness in treatment of adolescents with depression.
Wergeland, Gro Janne Henningsen; Håland, Åshild Tellefsen; Fjermestad, Krister Westlye; Öst, Lars Gøran; Gjestad, Rolf & Bjåstad, Jon Fauskanger [Show all 10 contributors for this article] (2023). Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behaviour Research and Therapy. ISSN 0005-7967. 169. doi: 10.1016/j.brat.2023.104400. Full text in Research Archive Show summary
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents’ credibility and expectancy of interventions should be targeted to optimize school-based CBT.
Fjermestad, Krister Westlye; Arnevåg, Sofie F; Öst, Lars Gøran; Kodal, Arne; Bjåstad, Jon Fauskanger & Heiervang, Einar Røshol [Show all 7 contributors for this article] (2023). Treatment motivation in child anxiety treatment – Factor structure and associations with outcomes. Psychiatry Research Communications. 3(4). doi: 10.1016/j.psycom.2023.100142. Full text in Research Archive Show summary
Motivation is associated with cognitive behavioral treatment (CBT) outcomes. We examined the factor structure of a motivation measure, and if motivation factors were differentially associated with CBT outcomes for children with anxiety. The sample comprised 179 children aged 8–15 years (M age = 11.5 years, SD = 2.1; 53.0% girls) with anxiety disorders who received CBT in a randomized controlled community clinic trial. Participants completed the Nijmegen Motivation List – child version (NML-C) at treatment onset. Outcomes were diagnostic recovery, anxiety/depression symptom and clinical severity change from pre-treatment to post-treatment, one-, and 3.9-years follow-up, and treatment dropout. Principal component analysis showed that the NML-C comprised two factors, preparedness (beliefs that CBT is useful and willingness to engage in treatment; 36.4% explained variance) and distress (discomfort from symptoms and perceived urgency to be helped; 12.7% explained variance). Higher preparedness predicted larger clinical severity reduction at post-treatment, alongside pre-treatment clinical severity. Higher distress predicted larger depression reduction at one-year follow-up, alongside pre-treatment depression. Higher preparedness predicted lower dropout. In conclusion, the NML-C comprises two factors that are differentially associated with CBT outcomes, but not above the effects of pre-treatment symptoms. Clinicians' focus on children's distress and preparedness could enhance CBT outcomes and reduce dropout.
Fjermestad, Krister Westlye; McLeod, Bryce D.; Silverman, Wendy K.; Bjåstad, Jon Fauskanger; Lerner, Matthew D. & Wergeland, Gro Janne Henningsen (2023). The Therapy Process Observational Coding System: Group cohesion scale in youth anxiety treatment: Psychometric properties. Journal of Clinical Psychology. ISSN 0021-9762. doi: 10.1002/jclp.23496. Full text in Research Archive
Rognstad, Kristian; Engell, Thomas; Fjermestad, Krister Westlye; Wentzel-Larsen, Tore & Kjøbli, John (2023). Process and Implementation Elements of Measurement Feedback Systems: A Systematic Review. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-023-01325-3. Full text in Research Archive Show summary
Abstract Measurement feedback systems (MFS) can help guide treatment and improve clinical outcomes. Studies of MFS are heterogeneous both in execution and results, and the effects of MFS seem restricted by limited attention to process and implementation elements and by limited adoption by health professionals. The current systematic review mapped the use of process and implementation elements in MFS studies. An overview of therapists’ use of and attitudes toward MFS is provided. Three-level meta-analyses were used to test theoretically informed process and implementation elements as moderators of the effects of MFS. Hypotheses and general propositions from Clinical Performance Feedback Intervention Theory (CP-FIT) were used to organize the elements of the studies and were used as moderator variables. Previous studies on MFS interventions have had a limited focus on implementation efforts and process elements that may increase the effects of MFS and their use among therapists. Efforts have sparsely been made to reduce barriers to MFS use, and several studies have reported limited engagement with MFS among therapists. Therapists’ attitudes toward MFS, feedback, or standardized measures were heterogeneously reported, making data synthesis challenging. Identified process and implementation elements were not significantly associated with effect sizes in the studies and the results did not support the propositions of CP-FIT. The lack of statistically significant associations may be due to limited reporting of details about process and implementation aspects. More research designed to test hypotheses regarding process and implementation elements is needed to improve the use and effects of MFS. Future studies should aspire to report findings in a manner that allows for an understanding of the implementation process and therapists’ adoption of these systems.
Orm, Stian; Wood, Jeffrey J.; Corbett, Blythe & Fjermestad, Krister Westlye (2023). Suicidal Risk Behaviors in Adolescents With Rare Neurodevelopmental Disorders: The Role of Sex, Autistic Traits, and Mental Health Difficulties. Journal of Pediatric Psychology. ISSN 0146-8693. 48(10), p. 852–860. doi: 10.1093/jpepsy/jsad051. Full text in Research Archive
Zapf, Holger; Boettcher, Johannes; Haukeland, Yngvild Bjartveit; Orm, Stian; Coslar, Sarah & Fjermestad, Krister Westlye (2023). A systematic review of the association between parent-child communication and adolescent mental health. JCPP Advances. 4(2). doi: 10.1002/jcv2.12205. Full text in Research Archive Show summary
Background This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health. Methods We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool. Results We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming. Conclusions The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.
Bjåstad, Jon Fauskanger; Gjestad, Rolf; Fjermestad, Krister Westlye; Öst, Lars Gøran; Haugland, Bente Storm Mowatt & Kodal, Arne [Show all 8 contributors for this article] (2023). Adherence, Competence, and Alliance as Predictors of Long-term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Research on Child and Adolescent Psychopathology. ISSN 2730-7166. 51, p. 761–773. doi: 10.1007/s10802-023-01028-1. Full text in Research Archive Show summary
The present study investigated therapist adherence, therapist competence, and patient-therapist alliance as predictors of long-term outcomes of cognitive behavioral therapy (CBT) for anxiety disorders in youth. Potential differential effects for group versus individual CBT, for therapists with or without formal CBT training, and based on youth symptom severity were examined. Videotapes (n = 181) from treatment sessions in a randomized controlled effectiveness trial comprising youth (N = 170, M age = 11.6 years, SD = 2.1) with anxiety disorders were assessed for therapist adherence and competence. Alliance was rated by therapists and youth. Participants completed a diagnostic interview and an anxiety symptom measure at pre-treatment, post-treatment, one-year follow-up, and long-term follow-up (M = 3.9 years post-treatment, SD = 0.8, range = 2.2–5.9 years). The change in anxiety symptoms or diagnostic status from pre-treatment to long-term follow-up was not significantly related to any predictor variables. However, several interaction effects were found. For loss of principal diagnosis, therapist competence predicted positive outcome when therapist adherence also was high. Adherence was found to predict positive outcome if CBT was provided individually. Therapist-rated alliance was related to both loss of principal diagnosis and loss of all diagnoses when CBT was provided in groups. Interaction effects suggested that therapists displaying both high adherence and high competence produced better long-term outcomes. Further, the alliance may be particularly important for outcomes in group CBT, whereas adherence may be particularly important for outcomes in individual CBT.
Fjermestad, Krister Westlye; Orm, Stian; Silverman, Wendy K. & Moreira, Hugo Cogo (2022). Short report: COVID-19-related anxiety is associated with mental health problems among adults with rare disorders. Research in Developmental Disabilities. ISSN 0891-4222. 123. doi: 10.1016/j.ridd.2022.104181. Full text in Research Archive Show summary
Background For adults with rare disorders, COVID-19 can be more severe and deadlier. This may lead to anxiety about COVID-19 among adults with rare disorders, including worries about being infected. COVID-19 anxiety is linked with mental health problems in the general population. Aims To examine the levels of mental health problems and COVID-19 anxiety, and their association, among adults with rare disorders. Methods and procedures Adults with rare disorders (N = 58, Mage = 45.2 years, SD = 12.7, 69.0% females, 31.0% males) answered standardized mental health and COVID-19 anxiety questionnaires online. Their scores were compared with samples without rare disorders. Outcomes and results Mental health problems were higher than in a sample without rare disorders (effect size d = 1.14), as was COVID-19 anxiety (effect size d = 0.53). COVID-19 anxiety correlated significantly with mental health problems (r = .46). Controlling for age, gender, and work status, COVID-19 anxiety explained 16.1% of the variance in mental health problems (ΔR2 = .161, p = .001). Conclusions and implications COVID-19 anxiety is higher than norms and associated with mental health problems for adults with rare disorders. During the pandemic, clinicians are recommended to assess COVID-19 anxiety for patients with rare disorders.
Fjermestad, Krister Westlye; Bellika, Katarina; Matre, Caroline; Silverman, Wendy K. & Wergeland, Gro Janne Henningsen (2022). Age and depressive symptoms change predict the 4-year self-concept trajectory for youth after anxiety treatment. Journal of Clinical Psychology. ISSN 0021-9762. 78(11), p. 2109–2121. doi: 10.1002/jclp.23427. Full text in Research Archive
Hafting, Marit; Puthy, Pat; Aadland, Gunn; Fjermestad, Krister Westlye & Jegannathan, Bhoomikumar (2022). Competence building in child mental health -A Norway-Cambodia transcultural experience. Nordic Psychology. ISSN 1901-2276. p. 19–19. doi: 10.1080/19012276.2022.2066561. Full text in Research Archive Show summary
The prevalence of mental health and neurodevelopmental disorders in young people is high in low- and middle-income countries. Collaboration between institutions from high-income countries and institutions in resource-poor settings may enhance professional competence. This may be a key to bridging the gap between service needs and ability to meet those needs. However, there are challenging issues in transferring knowledge from a Western context to a different cultural and socioeconomic situation. The aim of the present study is to describe significant aspect of a transcultural competence building project in Cambodia in child mental health from the perspective of the staff. A Norwegian expert team developed and implemented a program at Centre for Child and Adolescent Mental Health (Caritas-CCAMH) in collaboration with the staff two weeks per year over a 14-year period. The study has a qualitative approach using thematic analysis of the transcripts from a focus-group interview with 11 staff members at the end of the 14-year period. The multidisciplinary staff described a learning process characterized by collaboration in planning and implementation. Mixing theory and practice in clinical case discussions with a bio-psycho-social perspective was perceived as the cornerstone of the teaching process. A pedagogical strategy that involved constant reflection back and forth enabled the customization of the content and method of capacity building despite the differences in socio-economic conditions and learning styles. This model of continuity, low-investment, and low-intensity capacity-building may enrich the child and adolescent mental health settings in low- and middle-income countries.
Vatne, Torun Marie; Skjeggestad, Sigurd; Haukeland, Yngvild Bjartveit & Fjermestad, Krister Westlye (2022). A Qualitative Study of Men’s Experience of Being a Father in Families with Childhood Disability. Journal of Developmental and Physical Disabilities. ISSN 1056-263X. doi: 10.1007/s10882-022-09847-8. Full text in Research Archive
Zapf, Holger; Boettcher, Johannes; Haukeland, Yngvild Bjartveit; Orm, Stian; Coslar, Sarah & Wiegand-Grefe, Silke [Show all 7 contributors for this article] (2022). A Systematic Review of Parent–Child Communication Measures: Instruments and Their Psychometric Properties. Clinical Child and Family Psychology Review. ISSN 1096-4037. 26(1), p. 121–142. doi: 10.1007/s10567-022-00414-3. Full text in Research Archive Show summary
Parent–child communication represents an important variable in clinical child and family psychology due to its association with a variety of psychosocial outcomes. To give an overview of instruments designed to measure the quality of parent–child communication from the child’s (8–21 years) perspective and to assess the psychometric quality of these instruments, we performed a systematic literature search in Medline and PsycInfo (last: February 25, 2022). Peer-reviewed journal articles published in English with a child-rated instrument measuring the quality of parent–child communication were included. Initial screening for eligibility and inclusion, subsequent data extraction, and quality assessment were conducted by couples of review team members. Based on the screening of 5115 articles, 106 studies reported in 126 papers were included. We identified 12 parent–child communication instruments across the studies. The Parent-Adolescent Communication Scale (PACS) was used in 75% of the studies. On average, the evidence for psychometric quality of the instruments was low. Few instruments were used in clinical and at-risk samples. Several instruments are available to rate parent–child communication from the child’s perspective. However, their psychometric evidence is limited and the theoretical foundation is largely undocumented. This review has limitations with regard to selection criteria and language bias.
Wergeland, Gro Janne Henningsen; Posserud, Maj-Britt Rocio; Fjermestad, Krister Westlye; Njardvik, Urdur & Öst, Lars Gøran (2022). Early Behavioral Interventions for Children and Adolescents With Autism Spectrum Disorder in Routine Clinical Care: A Systematic Review and Meta-Analysis. Clinical Psychology. ISSN 0969-5893. 29(4). doi: 10.1037/cps0000106. Full text in Research Archive Show summary
The current paper systematically reviews and meta-analyses the effectiveness of early behavioral interventions (BI) for children with autism spectrum disorder (ASD) in routine clinical care. The effectiveness of BI, methodological study quality, and moderators of treatment outcome were examined and benchmarked with efficacy studies. The quality of the evidence was assessed with the Cochrane risk of bias tool. Twenty-nine studies were included, comprising 1,422 participants. Medium to large within-group effect sizes (g = 0.76–1.27) were found post-treatment for the outcome domains adaptive behavior, cognition, communication, and socialization, with large average effect size at post (g = 0.94) and at follow-up (g = 1.08). Comparison of effectiveness and efficacy studies showed that evidence-based early BI in routine clinical care yielded effects comparable to university research settings. The limitations include potential language and publication bias. The findings support evidence-based behavioral treatments delivered in routine clinical care as efficacious in reducing ASD symptoms.
Kirchhofer, Solveig Melanie; Orm, Stian; Haukeland, Yngvild Bjartveit; Fredriksen, Trude; Wakefield, Claire E. & Fjermestad, Krister Westlye (2022). A systematic review of social support for siblings of children with neurodevelopmental disorders. Research in Developmental Disabilities. ISSN 0891-4222. 126. doi: 10.1016/j.ridd.2022.104234. Full text in Research Archive Show summary
Background Social support is a protective factor for siblings of children with neurodevelopmental disorders. Aims We reviewed studies on social support received by siblings of children with neurodevelopmental disorders. Methods and procedures We conducted a pre-registered systematic review (CRD42020207686), searching PsycINFO, MEDLINE, Web of Science, and Scopus. Outcomes and results Fifteen articles were eligible for the review, 13 of which used cross-sectional designs. Two studies investigated sibling social support after an intervention. Multiple variables were negatively related to social support (e.g., sibling depression, loneliness, stress). Variables that were positively related to social support included prosocial behavior, competence (academic, social, and activity-related), problem-focused coping, and family quality of life. Potential moderators of the relationship between social support and psychosocial adjustment included the type of disorder of the affected sibling and the type of social support provider. We conclude with an overview of the reliability and validity of the seven social support measurements used across the studies. Conclusions and implications Lower levels of social support are associated with more negative psychosocial adjustment among siblings of children with neurodevelopmental disorders. We encourage future researchers to further investigate ways to increase social support for siblings to improve outcomes. Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Haukeland, Yngvild Bjartveit; Vatne, Torun Marie; Mossige, Svein & Fjermestad, Krister Westlye (2022). Psychosocial functioning in siblings of children with rare disorders compared to controls. The Yale Journal of Biology and Medicine. ISSN 0044-0086. 94(4), p. 537–544. Full text in Research Archive
Orm, Stian & Fjermestad, Krister Westlye (2021). A Scoping Review of Psychosocial Adjustment in Siblings of Children with Attention-deficit/hyperactivity disorder. Advances in Neurodevelopmental Disorders. ISSN 2366-7532. 5(4), p. 381–395. doi: 10.1007/s41252-021-00222-w. Full text in Research Archive Show summary
Objectives Siblings of children with neurodevelopmental disorders are at higher risk for psychosocial maladjustment than other children. The risk may differ between neurodevelopmental disorders. One group of siblings that has been largely neglected in research is siblings of children with attention-deficit/hyperactivity disorder (ADHD). The objective was to review all studies examining psychosocial adjustment in siblings of children with ADHD to identify research gaps. Methods We conducted a systematic literature search with keywords related to ADHD and siblings in PsycINFO, MEDLINE, and ERIC. We included studies that relied on clinical ADHD diagnosis, used control group(s) for sibling data, and/or examined within-sibling sample associations. We included 15 papers examining psychosocial adjustment in a total of 3729 siblings aged below 18 years. Results We identified four main psychosocial adjustment categories across studies: mental health (k = 10), family environment (k = 4) quality of life (k = 1), and resilience (k = 1). For mental health, most of the reviewed studies found that siblings had more mental health problems than controls, with small to large effect sizes. A few studies found no difference. For family environment, the reviewed studies suggested that siblings experience more family conflicts and less support than controls, with medium effect sizes. Compared to controls, siblings had poorer quality of life and less resilience (large effect). Conclusions Siblings of children with ADHD display poorer psychosocial adjustment than controls. However, research is scarce and more studies are needed that examine associations between psychosocial variables and effects of interventions.
Haukeland, Yngvild Bjartveit; Fjermestad, Krister Westlye; Mossige, Svein & Vatne, Torun Marie (2021). Parent-child communication about emotions during SIBS: a joint intervention for siblings and parents of children with chronic disorders. Nordic Psychology. ISSN 1901-2276. p. 1–18. doi: 10.1080/19012276.2021.1986850. Full text in Research Archive
Orm, Stian; Vatne, Torun Marie; Tomeny, Theodore S. & Fjermestad, Krister (2021). Empathy and Prosocial Behavior in Siblings of Children with Autism Spectrum Disorder: A Systematic Review. Review Journal of Autism and Developmental Disorders. ISSN 2195-7177. doi: 10.1007/s40489-021-00251-0. Full text in Research Archive Show summary
Siblings of children with Autism Spectrum Disorder (ASD) have, as a group, more autistic traits than typically developing individuals. A high prevalence of autistic traits may (or may not) include lower scores on measures of empathy and prosocial behavior, compared to individuals without ASD. The purpose of this study was to conduct a systematic review of studies of empathy and prosocial behavior in siblings of individuals with ASD. We conducted a comprehensive literature search of studies published until March 2020. We identified 16 studies with a total of 1066 siblings that met inclusion criteria. Based on this review, we conclude that the current literature suggests that siblings of individuals with ASD exhibit normative empathic abilities and prosocial behavior.
Orm, Stian; Haukeland, Yngvild; Vatne, Torun Marie; Silverman, Wendy K. & Fjermestad, Krister (2021). Prosocial behavior is a relative strength in siblings of children with physical disabilities or autism spectrum disorder. Journal of Developmental and Physical Disabilities. ISSN 1056-263X. doi: 10.1007/s10882-021-09816-7. Full text in Research Archive Show summary
Research on siblings of children with developmental and physical disabilities has emphasized negative influences on siblings’ mental health. Yet, such siblings may be more prosocial compared with siblings of children without disabilities, due to care responsibilities and their experiences with their brother’s or sister’s disability. We compared prosocial behavior between siblings of children with autism spectrum disorder (ASD; n = 47), physical disabilities (n = 42), and siblings of children without disabilities (n = 44) using a multi-informant approach (i.e., child-, mother-, and father-report). Prosocial behavior was measured with the Strengths and Difficulties Questionnaire. Drawing on the theoretical and empirical sibling literature, we also examined whether siblings’ internalizing and externalizing difficulties, adjustment to the sibling situation, and communication with parents correlated with siblings’ prosocial behavior. Child-reported internalizing difficulties and mother–child communication significantly correlated with mother-reported prosocial behavior. Child-reported internalizing and externalizing difficulties significantly correlated with father-reported prosocial behavior. No significant correlates with child-reported prosocial behavior was identified. When adjusting for siblings’ internalizing and externalizing difficulties and mother–child communication, siblings of children with physical disabilities scored significantly higher than siblings of children without disabilities on mother- and father-reported prosocial behavior. Siblings of children with ASD scored significantly higher on mother-reported prosocial behavior. We conclude that prosocial behavior may be a relative strength in siblings of children with developmental and physical disabilities, and that siblings’ prosocial behavior may be influenced by type of disability, mental health, and family communication. Interventions targeting siblings’ mental health and family communication may be helpful in promoting siblings’ prosocial behavior.
Fjermestad, Krister Westlye; Ditlefsen, Nina; Unsvåg, Marie H.; Öst, Lars Gøran; Havik, Odd E. & Wergeland, Gro Janne Henningsen (2021). Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes. Journal of Child and Family Studies. ISSN 1062-1024. 31, p. 1–13. doi: 10.1007/s10826-021-02188-8. Full text in Research Archive Show summary
To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.
Fredriksen, Trude; Vatne, Torun Marie; Haukeland, Yngvild Bjartveit; Tudor, Megan & Fjermestad, Krister Westlye (2021). Siblings of children with chronic disorders: Family and relational factors as predictors of mental health. Journal of Child Health Care. ISSN 1367-4935. doi: 10.1177/13674935211052157. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at increased risk of mental health problems. Predictors of siblings' mental health require further study to identify children in need of interventions and to design effective intervention programs. Siblings of children with chronic disorders (n = 107; M age = 11.5 years; SD = 2.1, 54.6% girls) and their parents (n = 199; 50.3% mothers) were included in a survey study. Siblings and parents completed questionnaires on mental health. Siblings completed questionnaires on parent-child communication, relationships with parents, and an adjustment measure on the sibling situation. Multiple linear regression analyses were applied to identify predictors of siblings' mental health. Sibling-reported relationship with parents was a significant predictor of sibling mental health reported by siblings, fathers, and mothers (R2 = 0.26 - R2 = 0.46). Siblings' adjustment was significantly associated with fathers' report of siblings' mental health (r = .36), but not mothers' report (r = .17). Siblings' relationships (d = 0.26) and communication (d = 0.33) with mothers were significantly better than with fathers. We conclude that the sibling-parent relationship is a significant factor in identifying siblings at risk and that family-based intervention programs should be developed. Keywords: Siblings; chronic disease; fathers; mental health; mothers; multiple chronic conditions.
Vatne, Torun Marie; Owren, Signe; Wold, Kristin Fjelnseth; Zahl, Erica & Fjermestad, Krister (2021). Youth and clinician evaluation of emotional communication in short-term counseling groups. Group Dynamics. ISSN 1089-2699. doi: 10.1037/gdn0000147. Full text in Research Archive Show summary
Objectives: Group interventions are recommended to prevent psychological difficulties in siblings of children with a disability. However, emotional communication and support in such groups have not previously been described or evaluated. This article describes two studies to provide such knowledge. Methods: Study 1 examined communication patterns following expressions of negative emotions in counseling groups for siblings of children with a disability. We videotaped and transcribed communication patterns in 17 counseling group sessions for siblings of children with a disability aged 11–16 years. We applied content analysis to identify communication patterns following expressions of negative emotion(s). Study 2 examined youth- and clinician-evaluated supportiveness of the four most frequent patterns from Study 1. Reenacted video examples of the patterns were shown to 136 school pupils aged 11–16 years and 68 clinicians, who rated each pattern for supportiveness using visual analog scales. Results: In Study 1, the communication was found to be either child-centered or adult-centered. Frequent adult-centered communication patterns were interviewing, informing, or avoiding. Child-centered communication often followed a consenting pattern, in which other children expressed having similar experiences. The four patterns were all rated low to medium on support by youths and clinicians in Study 2. Youths found the avoiding pattern to be more supportive than clinicians, and girls and older youths differed from boys and younger youths in their evaluation of the consenting pattern. Conclusions: The results of the two studies highlight the importance of training group leaders in child-centered communication and the ability to facilitate communication patterns experienced as supportive by youths. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Orm, Stian; Vatne, Torun Marie; Haukeland, Yngvild; Silverman, Wendy K. & Fjermestad, Krister (2021). The validity of a measure of adjustment in siblings of children with developmental and physical disabilities: a brief report. Developmental Neurorehabilitation. ISSN 1751-8423. 24(5), p. 355–358. doi: 10.1080/17518423.2020.1869338. Full text in Research Archive Show summary
Background: Few questionnaires are tailored for siblings of children with disabilities. The Negative Adjustment Scale (NAS) was developed to measure siblings’ adjustment, but has not yet been validated. Objective: To investigate the factor structure and convergent validity of the NAS. Method: We examined the validity of the NAS in terms of factor structure and convergent validity against a general mental health measure. The sample comprised 107 siblings (M age = 11.5 years, SD = 2.1, 53.8% boys) of children with disabilities. Results: We confirmed a one-factor structure for the NAS. Convergent validity was demonstrated through significant correlations (r=.29–.44) with sibling externalizing and internalizing mental health difficulties. Conclusion: The NAS holds promise as a measure tailored for the assessment of sibling’s adjustment.
Orm, Stian; Haukeland, Yngvild Bjartveit; Vatne, Torun & Fjermestad, Krister (2021). Measuring family communication in pediatric nursing: Psychometric properties of the Parent-Child Communication Scale – Child Report (PCCS-CR). Journal of Pediatric Nursing : Nursing Care of Children and Families. ISSN 0882-5963. 62, p. 78–83. doi: 10.1016/j.pedn.2021.10.022. Full text in Research Archive Show summary
Purpose: Communication quality is an essential indicator of family functioning and represents an important outcome after pediatric nursing interventions. However, few well-documented child-report questionnaires for family communication exist. We aimed to document the psychometric properties of a previously developed child-rated family communication scale for use in pediatric nursing. Design and Methods: We examined the Parent-Child Communication Scale – Child Report (PCCS-CR) in terms of factor structure, convergent validity against the Experiences in Close Relationships-Relationship Structures scale (ECR-RS), and discriminant validity between a sample of siblings of children with pediatric health conditions and controls. The sample comprised 101 siblings of children with a pediatric health condition and 44 controls (M age = 11.5 years, SD = 2.2). Results: We confirmed a two-factor structure of the PCCS-CR. One factor is communication from the child to the parent, labelled child communication (e.g., “I discuss problems with my parents”) and the other is communication from the parent to the child, labelled parent communication (e.g., “My parent is a good listener”). Convergent validity of the PCCS-CR was demonstrated through correlations with ECR-RS (r = -.73 to -.22, p ≤ .05). Further, construct validity through differences between families with and without a child with a pediatric health condition was demonstrated (g = .36-.83, p ≤ .052). Conclusion: The PCCS-CR appears to be a psychometrically sound measure of parent-child communication from the child’s point of view. Practical implications: The PCCS-CR can be administered in pediatric nursing care and can be used to target and measure the outcomes of interventions aimed at enhancing family functioning.
Husabo, Elisabeth; Haugland, Bente Storm Mowatt; McLeod, Bryce D.; Baste, Valborg; Håland, Åshild Tellefsen & Bjåstad, Jon Fauskanger [Show all 12 contributors for this article] (2021). Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety. School Mental Health. ISSN 1866-2625. 14(1), p. 62–62. doi: 10.1007/s12310-021-09458-2. Full text in Research Archive Show summary
To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth . Coders ( N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators ( M age = 43.2 years, SD = 8.1) to 295 youth ( M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.
Fjermestad, Krister; Kanavin, Øivind J.; Hoxmark, Lise Beate & Nyhus, Livø (2020). Health service experiences among adults with hereditary spastic paraparesis or neurofibromatosis type 1. Molecular Genetics & Genomic Medicine. ISSN 2324-9269. 8, p. e1399–e1399. doi: 10.1002/mgg3.1399. Full text in Research Archive Show summary
Background Persons with rare disorders may experience poorer health services due to limited knowledge about rare disorders among health professionals. Knowledge about how persons with rare disorders perceive health services can help inform service providers to enhance their practices. Methods We conducted a self‐report survey among adults with the rare disorders hereditary spastic paraparesis (HSP; n = 108; mean age 57.7 years; 54.2% females) and neurofibromatosis type 1 (NF1, n = 142; mean age = 50.3 years; 62.0% females). Their responses concerning perceived health experiences were compared to healthy controls from the population study HUNT‐3 (n = 7,312). Results Both rare disorder groups reported lower satisfaction, trust, and participation in meetings with their general practitioner and specialist health services. More reported health problems were overall associated with poorer health service experiences. Conclusion There is a need to identify predictors of health service experiences at the patient and health service provider levels with the aim to tighten the gap between the health experiences of patients with and without rare disorders.
Fjermestad, Krister; Huster, Rene; Thunberg, Christina; Stokke, Simen; Gravholt, Claus H & Solbakk, Anne-Kristin (2020). Neuropsychological functions, sleep, and mental health in adults with Klinefelter syndrome. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics (AJMG). ISSN 1552-4868. 184C, p. 482–492. doi: 10.1002/ajmg.c.31797. Full text in Research Archive Show summary
A few studies have examined neuropsychological functions, sleep, and mental health combined in Klinefelter syndrome (KS; 47,XXY). We investigated neuropsychological functions with standard tests, sleep with actigraphy, and self-reported mental health in 30 men with KS (Mean age = 36.7 years) compared to 21 controls (Mean age = 36.8 years). Men with KS scored significantly lower on mental speed, attention span, working memory, inhibition, and set-shifting tests, as well as overall IQ (mean effect size difference Cohen's d = 0.79). Men with KS had significantly longer night wakes, with no differences in other sleep variables (mean d = 0.34). Men with KS reported poorer mental health than controls (mean d = 1.16). Regression analyses showed neuropsychological functions explained variance in some sleep domains for men with KS but not for controls. Neuropsychological functions explained variance in some mental health domains for controls. For men with KS, however, verbal IQ was the only significant predictor of mental health. Altogether, men with KS display problems in neuropsychological functions and mental health but do not appear different from controls on most sleep parameters. Our findings indicate that relations between neuropsychological functions, sleep, and mental health differ between men with KS and controls.
Fjermestad, Krister; Lium, Christina; Heiervang, Einar; Havik, Odd E.; Haugland, Bente Storm Mowatt & Bjelland, Ingvar [Show all 7 contributors for this article] (2020). Parental internalizing symptoms as predictors of anxiety symptoms in clinic-referred children. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 8, p. 18–24. doi: 10.21307/sjcapp-2020-003. Full text in Research Archive Show summary
Background: Mothers’ and fathers’ internalizing symptoms may influence children’s anxiety symptoms differently. Objective: To explore the relationship between parental internalizing symptoms and children’s anxiety symptoms in a clinical sample of children with anxiety disorders. Method: The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children’s anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (Mage = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models. Results: Both mother and father rated internalizing symptoms predicted children’s self-rated anxiety levels (adj. R2 = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R2 = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children. Conclusions: Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations.
Fjermestad, Krister; Anthonisen, Ingvild; Haugland, Bente Storm Mowatt; Kodal, Arne; Bjåstad, Jon Fauskanger & Wergeland, Gro Janne (2020). Sammenhengen mellom behandlingsfornøydhet og effekt av kognitiv atferdsterapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. Full text in Research Archive
Haukeland, Yngvild; Czajkowski, Nikolai Olavi; Fjermestad, Krister; Silverman, Wendy K.; Mossige, Svein & Vatne, Torun (2020). Evaluation of “SIBS”, An Intervention for Siblings and Parents of Children with Chronic Disorders. Journal of Child and Family Studies. ISSN 1062-1024. 29. doi: 10.1007/s10826-020-01737-x. Full text in Research Archive Show summary
Siblings of children with chronic disorders are at increased risk of experiencing family communication problems and poorer mental health. We assessed initial feasibility, acceptability, and outcomes of SIBS; a manual-based group intervention for siblings and parents of children with chronic disorders, aiming to improve parent-sibling communication and sibling mental health. Ninety-nine siblings aged 8–16 years (M = 11.5 years, SD = 2.0; 54.5% girls) and parents (63.6% mothers) of children with chronic disorders participated in three separate group sessions for siblings and parents and two joint sessions with integrated sibling-parent dialogues. We assessed participant satisfaction post-intervention and checked for group leader manual adherence. We measured the following outcomes at baseline, three, and six months post-intervention in an open trial: (1) parent-sibling communication quality; (2) sibling emotional and behavioral problems; (3) sibling adaptation to the disorder; and (4) sibling disorder knowledge. Using growth curve modeling, we found significant improvement in parent-sibling communication quality (p = 0.001), emotional and behavioral problems (p = 0.009), adaptation to the disorder (p = 0.003), and disorder knowledge (p = 0.000) from baseline to follow-up (effect sizes d = 0.22 to 0.64). Improvement in sibling-reported emotional and behavioral problems and adaptation to the disorder was partly explained by communication quality. User satisfaction was high and manual adherence was good. Our evaluation yields support for the SIBS intervention, with initial evidence of acceptability, feasibility, and beneficial outcomes. Our study suggests targeting parent-sibling communication may be a beneficial way of improving siblings’ mental health.
Fjermestad, Krister; Wergeland, Gro Janne; Rogde, Anja Høye; Bjåstad, Jon Fauskanger; Heiervang, Einar & Haugland, Bente Storm (2020). School-based targeted prevention compared to specialist mental health treatment for youth anxiety. Child and Adolescent Mental Health. ISSN 1475-357X. 25(2), p. 102–109. doi: 10.1111/camh.12366. Full text in Research Archive Show summary
Background The ‘FRIENDS for life’ program (FRIENDS) is a 10-session cognitive behavioral therapy (CBT) program used for prevention and treatment of youth anxiety. There is discussion about whether FRIENDS is best applied as prevention or as treatment. Methods We compared FRIENDS delivered in schools as targeted prevention to a previous specialist mental health clinic trial. The targeted prevention sample (N = 82; Mage = 11.6 years, SD = 2.1; 75.0% girls) was identified and recruited by school nurses in collaboration with a community psychologist. The clinical sample (N = 88, Mage = 11.7 years, SD = 2.1; 54.5% girls) was recruited for a randomized controlled trial from community child- and adolescent psychiatric outpatient clinics and was diagnosed with anxiety disorders. Results Both samples showed significantly reduced anxiety symptoms from baseline to postintervention, with medium mean effect sizes across raters (youths and parents) and timepoints (post; 12-months follow-up). Baseline youth-reported anxiety symptom levels were similar between the samples, whereas parent-reported youth anxiety was higher in the clinical sample. Conclusions The study suggests that self-reported anxiety levels may not differ between youth recruited in schools and in clinic settings. The results indicate promising results of the FRIENDS program when delivered in schools by less specialized health personnel from the school health services, as well as when delivered in clinics by trained mental health professionals.
Fjermestad, Krister; Silverman, Wendy K. & Vatne, Torun (2020). Group intervention for siblings and parents of children with chronic disorders (SIBS-RCT): Study protocol for a randomized controlled trial. Trials. 21(1), p. 851–851. doi: 10.1186/s13063-020-04781-6. Full text in Research Archive Show summary
Background Siblings and parents of children with neurodevelopmental disorders are at risk of mental health problems and poorer family communication. Some group interventions for siblings exist, but few have clearly described parent components and none are considered evidence-based. Methods We are conducting a randomized controlled trial comparing a five-session manual-based group intervention for siblings (aged 8 to 16 years) and parents of children with neurodevelopmental disorders to a 12-week waitlist, called SIBS-RCT. The intervention comprises three separate sibling and parent group sessions and two joint sessions in which each sibling talks to their parent alone. The intervention aims at improving parent-child communication and covers themes such as siblings’ understanding of the neurodevelopmental disorder, siblings’ emotions, and perceived family challenges. Participants are recruited through municipal and specialist health centers across Norway. The primary outcome is sibling mental health. Quality of life and family communication are secondary outcomes. Participants are block-randomized to the intervention or 12-week waitlist in groups of six. Measures are collected electronically at pre- and post-intervention/waitlist, as well as 3, 6, and 12 months post-intervention. The main effect to be examined is the difference between the intervention and waitlist at 12 weeks post. All outcomes will also be examined using growth curve analyses. We plan to include 288 siblings and their parents by the end of 2022. Discussion SIBS-RCT represents a major contribution to the research and practice field towards establishing an evidence-based intervention for siblings. In the event that intervention and waitlist are no different, the impact of SIBS-RCT is still substantial in that we will aim to identify participant subgroups that show positive response and effective components of the SIBS manual by examining group leader adherence as an outcome predictor. This will allow us to continue to re-engineer the SIBS manual iteratively to improve outcomes, and avoid the promotion of a less-than-optimal intervention. Trial registration ClinicalTrials.gov NCT04056884. Registered in August 2019

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Nybakken, Gunn; Skogli, Erik Winther; Fjermestad, Krister Westlye & Orm, Stian (2026). Persontilpasset kartlegging av vansker hos barn og unge med autisme. Full text in Research Archive Show summary
Youth Top Problems er et persontilpasset klinisk intervju som kan være et supplement til standardiserte kartleggingsinstrumenter i BUP. Videre kan YTP fungere som et ledd i målingsbasert behandling (Measurement-Based Care) og bidra til mer positive og pasientorienterte behandlingsutfall for barn og unge med autisme.
Nybakken, Gunn; Orm, Stian; Fredriksen, Trude; Skogli, Erik Winther; Kirchhofer, Solveig Melanie & Vatne, Torun Marie [Show all 7 contributors for this article] (2026). The Impact of Children’s Co-Occurring Emotional and Behavioral Problems on Sibling and Parent Psychosocial Functioning. Full text in Research Archive Show summary
Latent Profile Analysis (LPA) was conducted to estimate subgroups of EBPs in a sample of 225 children with a developmental disorder. We identified 4 clinically meaningful subgroups of EBPs among children with developmental disorders. The profiles with high levels of disruptive behavior and social difficulties have a particularly negative impact on parent and sibling psychosocial functioning.
Arora, Tarun; Fossmo, Hanne Ludt; Raastad, Truls; Fjermestad, Krister Westlye; Ramberg, Cathrine & Nilsen, Kristian Bernhard [Show all 12 contributors for this article] (2025). 314P Personalized training for people with rare neuromuscular disorders (PETRA-NMD): a multi-center randomized controlled clinical trial. Neuromuscular Disorders. ISSN 0960-8966. 53(Supplement, September), p. 75–75. doi: 10.1016/j.nmd.2025.105738. Full text in Research Archive
Dechsling, Anders; Cipriano, Christina; Børtveit, Line; Fjermestad, Krister Westlye; Karlsen, Ann-Charlott Beatrice Amundsen & Akerbæk, Tore Marius [Show all 8 contributors for this article] (2025). Examining the effectiveness of Second Step Early Learning versus free play on socio-emotional learning in kindergarten: a cluster randomized controlled trial protocol. doi: 10.1186/s13063-025-09047-7. Full text in Research Archive
Prentice, Caitlin Mccombs; Kirchhofer, Solveig Melanie; Vatne, Torun Marie & Fjermestad, Krister Westlye (2025). SIBS-RCT: Improving mental health for siblings of children with chronic disorders. Full text in Research Archive Show summary
SIBS-RCT: Improving mental health for siblings of children with chronic disorders Caitlin Prentice, Solveig M. Kirchhofer, Torun M. Vatne, Krister W. Fjermestad Background The educational inclusion of children with chronic disorders – such as developmental and physical disabilities – is a well-studied area. The siblings of these children, however, are less studied, particularly in relation to their educational experiences and outcomes. Siblings of children with chronic disorders have divergent, and often adverse, life experiences, and are known to be at risk for negative psychological effects including emotional and behavioural problems (Havill et al., 2019; Vermaes et al., 2012). Reduced psychological well-being, in turn, can affect siblings’ educational experiences, functioning, and outcomes (Gan et al., 2017). “SIBS”, short for “siblings”, is a therapeutic intervention programme for siblings and parents of children with chronic disorders which aims to improve the emotional and behavioural well-being of siblings and to improve communication between parents and siblings (Fjermestad et al., 2020). In this presentation, I report findings from an evaluation of this programme, the SIBS-RCT, with a particular focus on teacher perspectives on siblings’ well-being and functioning at school. Methods Participants were recruited from healthcare services that provide support to children with chronic disorders and their families across Norway. The SIBS intervention consists of five sessions, with separate and joint sibling and parent components. Data were collected via questionnaire at baseline and at 3, 6, and 12 months following the intervention, and included the Strengths and Difficulties Questionnaire (SDQ). The SDQ is a measure of children’s behavioural and emotional functioning composed of 25 items organised into five subscales: emotional difficulties, conduct problems, hyperactivity and inattention, peer difficulties, and pro-social behaviour. Siblings’ parent-rated SDQ scores (n=288) were compared with controls using intention to treat (ITT) and complier average causal effects (CASE). A subsample of teacher reported SDQ scores (n=125) were compared with mother and father reported scores. Results The SIBS intervention was found to have a small positive effect on sibling mental health compared with the waitlist control group. Teachers rated siblings as having fewer problem behaviours on the SDQ than parents, both in a comparison with population norms and clinical cutoff levels. For boys, teachers rated only hyperactivity-inattention as higher than norms, while for girls, teacher scores were higher than norms for total difficulties, emotional problems, hyperactivity-inattention and peer problems. In contrast, mothers and fathers rated siblings as having higher levels of problems across almost every subscale of the SDQ. Prosocial behaviour was a relative strength of siblings across both teacher and parent ratings. Conclusions These findings suggest that siblings’ difficulties are less present in a school environment than at home, adding to an extant literature on children’s context specific behaviour (De Los Reyes & Kazdin, 2005), Our findings could also be partially the result of teachers being less able to spot “quieter” internalising problems than parents. Causes of the gender differences found in teacher-rated SDQ scores are unclear, but point towards potential differences in expectations for girl versus boy siblings in terms of care giving behaviours. References De Los Reyes, A., & Kazdin, A. E. (2005). Informant Discrepancies in the Assessment of Childhood Psychopathology: A Critical Review, Theoretical Framework, and Recommendations for Further Study. Psychological Bulletin, 131(4), 483–509. https://doi.org/10.1037/0033-2909.131.4.483 Fjermestad, K. W., Silverman, W. K., & Vatne, T. M. (2020). Group intervention for siblings and parents of children with chronic disorders (SIBS-RCT): Study protocol for a randomized controlled trial. Trials, 21(1), 851. https://doi.org/10.1186/s13063-020-04781-6 Gan, L. L., Lum, A., Wakefield, C. E., Nandakumar, B., & Fardell, J. E. (2017). School Experiences of Siblings of Children with Chronic Illness: A Systematic Literature Review. Journal of Pediatric Nursing, 33, 23–32. https://doi.org/10.1016/J.PEDN.2016.11.007 Havill, N., Fleming, L. K., & Knafl, K. (2019). Well siblings of children with chronic illness: A synthesis research study. Research in Nursing & Health, 42(5), 334–348. https://doi.org/10.1002/nur.21978 Vermaes, I. P. R., van Susante, A. M. J., & van Bakel, H. J. A. (2012). Psychological Functioning of Siblings in Families of Children with Chronic Health Conditions: A Meta-Analysis. Journal of Pediatric Psychology, 37(2), 166–184. https://doi.org/10.1093/jpepsy/jsr081
Haugen, Ingvild; Gulsrud, Anne Myge; Dyresen, Agnete; Stubberud, Jan Egil; Fjermestad, Krister Westlye & Øie, Merete Glenne (2025). Adolescents with ADHD and their caregivers find Goal Management Training as credible as standard treatment. Full text in Research Archive
Veerman, Linda K.M.; Orm, Stian; Fjermestad, Krister Westlye; Sterkenburg, Paula S. & Willemen, Agnes M. (2025). Next steps in the development of a sibling adjustment scale: reply to Supianto. International Journal of Developmental Disabilities (IJDD). ISSN 2047-3869. 71(2), p. 205–207. doi: 10.1080/20473869.2025.2456803. Full text in Research Archive
Gulsrud, Anne Myge; Haugen, Ingvild; Dyresen, Agnete; Westlye, Lars Tjelta; Alnæs, Dag & Fjermestad, Krister Westlye [Show all 8 contributors for this article] (2025). iPad-based Assessment of Executive Function and Processing Speed in Adolescents with ADHD. Full text in Research Archive
Dyresen, Agnete; Fjermestad, Krister Westlye; Kodal, Arne; Orm, Stian; Posserud, Maj-Britt Rocio & Øie, Merete Glenne [Show all 7 contributors for this article] (2025). The Role of Externalizing Symptoms on Long-term Treatment Outcomes in Youth with Anxiety Disorders. Full text in Research Archive
Dyresen, Agnete; Haugen, Ingvild; Gulsrud, Anne Myge; Stubberud, Jan Egil; Fjermestad, Krister Westlye & Øie, Merete Glenne (2025). Adapting Metacognitive Strategy Training for Adolescents with ADHD. Full text in Research Archive
Dechsling, Anders; Cipriano, Christina; Børtveit, Line; Fjermestad, Krister Westlye; Karlsen, Ann-Charlott Beatrice Amundsen & Akerbæk, Tore Marius [Show all 8 contributors for this article] (2025). Examining the Effectiveness of Second-Step Early Learning versus Free Play on Socioemotional Learning in Kindergarten: A Cluster Randomized Controlled Trial Protocol. doi: https:/link.springer.com/article/10.1186/s13063-025-09047-7. Full text in Research Archive
Øie, Merete Glenne; Haugen, Ingvild; Dyresen, Agnete; Gulsrud, Anne Myge; Stubberud, Jan Egil & Fjermestad, Krister Westlye (2024). Behovet er stort for nye tilnærminger til ADHD-behandling. Debattinlegg. Aftenposten. Full text in Research Archive
Fjermestad, Krister Westlye (2024). Å være søsken til et barn med cranofacial tilstand. Full text in Research Archive
Fjermestad, Krister Westlye (2024). Learn key elements in the SIBS intervention for siblings and parents for children with chronic disorders. Full text in Research Archive
Fjermestad, Krister Westlye & Vatne, Torun Marie (2024). Learn key elements in the SIBS intervention for siblings and parents of children with chronic disorders. Full text in Research Archive
Orm, Stian; Øie, Merete Glenne; Fossum, Ingrid Nesdal; Fjermestad, Krister Westlye; Andersen, Per Normann & Skogli, Erik Winther (2023). Executive Functioning and Anxiety/Depressive Symptoms as Mediators Between ADHD and Quality of Life: A 10-year Longitudinal Study. Full text in Research Archive Show summary
Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with impaired executive functioning and anxiety/depressive symptoms, which may contribute to reduced quality of life. We tested the hypotheses that (1) a childhood diagnosis of ADHD is related to reduced quality of life in emerging adulthood and that (2) this relationship is mediated by impaired executive functioning and anxiety/depressive symptoms. Participants and Methods: We assessed 85 children and adolescents with ADHD and 50 typically developing peers at baseline (Mean age = 11.6 years, 58% males), two-year follow-up, and 10-year follow-up with neuropsychological tests of executive functioning, the Behavioral Rating Inventory of Executive Function (BRIEF), the Short Moods and Feelings Questionnaire (SMFQ), and the Revised Children’s Manifest Anxiety Scale, second edition (RCMAS-2), as well as the Perceived Quality of Life scale (PQoL) at the 10-year follow-up. Four neuropsychological tests of executive functioning, the Letter-Number Sequencing test (working memory), the Color-Word Interference test condition 3 (response inhibition), the Color-Word Interference test condition 4 (shifting), and the trail making test condition 4 (cognitive flexibility) were combined into a neuropsychological executive functioning composite score based on high factor loadings (≥ .73). the parent-reported BRIEF indexes, the behavioral regulation index, and the metacognition index were used as measures of everyday executive functioning. We conducted independent samples t-tests to compare the groups and simple and parallel mediation analyses with full information maximum likelihood estimation to examine whether the different executive functioning measures and anxiety/depressive symptoms at two-year follow-up mediated the relationship between baseline ADHD and self-reported quality of life at 10-year follow-up. Results: Baseline ADHD was associated with more difficulties with executive functioning on a composite measure of neuropsychological tests (p < .001, Hedges g = .79) and parent-reported everyday metacognitive (p < .001, Hedges g = 2.37) and behavioral regulation executive functioning (p < .001, Hedges g = 1.55), as well as self-reported anxiety (p < .001, Hedges g = 1.05) and depressive symptoms (p < .001, Hedges g = 1.00) at two-year follow-up. Baseline ADHD was associated with lower self-reported quality of life (p = .001, Hedges g = -.67) at 10-year follow-up. The mediation analysis showed that everyday metacognitive executive functioning (p = .011, β = -.497) and an anxiety/depressive symptoms composite (p < .001, β = -.404) parallelly mediated the relationship between ADHD and quality of life. Conclusions: Impaired everyday executive functioning and anxiety/depressive symptoms may represent two distinct pathways to reduced quality of life in emerging adults with a childhood diagnosis of ADHD. These findings stress the importance of targeting both cognitive and emotional aspects in interventions for children and adolescents with ADHD to improve later quality of life.
Fjermestad, Krister Westlye (2023). Learn key elements in the SIBS intervention for siblings and parents of children with chronic disorders. Full text in Research Archive
Bjåstad, Jon Fauskanger; Gjestad, Rolf; Fjermestad, Krister Westlye; Öst, Lars Gøran; Haugland, Bente Storm Mowatt & Kodal, Arne [Show all 8 contributors for this article] (2023). Does adherence, competence and alliance predict long-term outcome in CBT for anxiety disorders in youth. Full text in Research Archive
Bjåstad, Jon Fauskanger; Öst, Lars Gøran; Wergeland, Gro Janne Henningsen; Fjermestad, Krister Westlye; Kommedal, Christian & Bouchard, S. [Show all 7 contributors for this article] (2023). Feasability of Virtual Reality in CBT for Anxiety Disorders in a Child and Adolescent Mental Health Service (CAMHS) : symposium The future is Now: Paediatric Mental Health Service Innovations. Full text in Research Archive
Kirchhofer, Solveig Melanie; Orm, Stian; Haukeland, Yngvild Bjartveit; Fredriksen, Trude; Wakefield, Claire E. & Fjermestad, Krister Westlye (2022). A systematic review of social support of siblings of children with neurodevelopmental disorders. doi: https:/www-sciencedirect-com.ezproxy.uio.no/science/article/pii/S0891422222000646. Full text in Research Archive
Orm, Stian; Haukeland, Yngvild; Vatne, Torun Marie & Fjermestad, Krister Westlye (2022). Parent-Sibling Communication and Mental Health in Siblings of Children with Autism Spectrum Disorder Compared with Physical Disabilities. Full text in Research Archive
Fredriksen, Trude & Fjermestad, Krister Westlye (2021). Gjeommføring av SIBS RCT i spesialisthelsetjenesten - utfordringer og muligheter. Full text in Research Archive
Fjermestad, Krister Westlye (2021). Søskenprosjektet SIBS. Full text in Research Archive
Fjermestad, Krister Westlye (2021). Å være foreldre til barn med funksjonsnedsettelse. Full text in Research Archive
Orm, Stian; Parken, Andrine Krogh; Haukeland, Yngvild; Mossige, Svein; Fjermestad, Krister & Vatne, Torun (2020). Siblings' Experience of Violence from Their Brother or Sister with a Neurodevelopmental Disorder. Full text in Research Archive
Orm, Stian & Fjermestad, Krister (2020). Prosocial Behavior in Siblings of Children with Autism Spectrum Disorder: A Case-Control Study. Universitetet i Oslo. Full text in Research Archive Show summary
Background: Some studies have suggested that siblings of children with chronic disorders display higher empathy and more prosocial behavior than typically developing (TD) children. However, the evidence with regards to siblings of children with Autism Spectrum Disorder (ASD) is mixed. Studies have shown that siblings of children with ASD are at higher risk than TD children of psychosocial impairments, including lower social functioning and social cognitive deficits. The first aim of the current study was to compare the prosocial behavior of siblings of children with ASD to siblings of children with physical disabilities and TD children. The second aim was to investigate intra- and interpersonal predictors of prosocial behavior among siblings of children with ASD. Method: The dataset was drawn from baseline data in the SIBS project, a project investigating the feasibility and effectiveness of a group intervention for siblings and parents of children with chronic disorders. In the current study, three groups were included; (1) siblings of children with ASD (n = 47), (2) siblings of children with physical disabilities (n = 42), and (3) TD controls (n = 44). Siblings prosocial behavior and mental health were assessed with the Strengths and Difficulties Questionnaire, siblings’ adaptation to their brother’s or sister’s disorder was assessed with the Negative Adjustment Scale, and parent-child communication was assessed with the Parent-Child Communication Scale. Results: There were no significant differences between siblings of children with ASD and siblings of children with physical disabilities or TD controls in prosocial behavior. Siblings’ mental health, negative adaptation, and parent-child communication explained 25% of the variance in father-reported prosocial behavior among siblings of children with ASD. However, only siblings’ externalizing difficulties was a significant predictor. Conclusion: Siblings of children with ASD display normative levels of prosocial behavior. Intra- and interpersonal variables have little impact on prosocial behavior among siblings of children with ASD.