research abstract child and adolescent development

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National Research Council (US) and Institute of Medicine (US) Forum on Adolescence; Kipke MD, editor. Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research. Washington (DC): National Academies Press (US); 1999.

Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research.

• Hardcopy Version at National Academies Press

Changes in the Study of Adolescent Development

Over the last two decades, the research base in the field of adolescent development has undergone a growth spurt. Knowledge has expanded significantly. New studies have allowed more complex views of the multiple dimensions of adolescence, fresh insights into the process and timing of puberty, and new perspectives on the behaviors associated with the second decade of life. At the same time, the field's underlying theoretical assumptions have changed and matured.

Researchers of human development have consistently observed that the second decade of life is a time of dramatic change: a period of rapid physical growth, endocrine (hormone) changes, cognitive development and increasing analytic capability; emotional growth, a time of self-exploration and increasing independence, and active participation in a more complex social universe. For much of this century, scientists and scholars studying adolescence tended to assume that the changes associated with adolescence were almost entirely dictated by biological influences. It has been viewed as a time of storm and stress, best contained or passed through as quickly as possible. Adolescence , a 1904 book by G. Stanley Hall, typified this standpoint. It was Hall who popularized the notion that adolescence is inevitably a time of psychological and emotional turmoil (Hall, 1904). Half a century later, psychoanalytic writers including Anna Freud accepted and augmented Hall's emphasis on turmoil (Petersen, 1988). Even today, "raging hormones" continue to be a popular explanation for the lability, aggression, and sexual activity associated with adolescence (Litt, 1995). Intense conflict between adolescents and their parents is often considered an unavoidable consequence of adolescence (Petersen, 1988). However, this assumption is not supported by scientific evidence. The assumption that turmoil and conflict are inevitable consequences of the teenage years may even have prevented some adolescents from receiving the support and services they needed.

Research is now creating a more realistic view of adolescence. Adolescence continues to be seen as a period of time encompassing difficult developmental challenges, but there is wider recognition that biology is only one factor that affects young people's development, adjustment, and behavior. In fact, there is mounting evidence that parents, members of the community, service providers, and social institutions can both promote healthy development among adolescents and intervene effectively when problems arise.

The study of adolescence is now becoming an increasingly sophisticated science. Thanks to powerful new research tools and other scientific and technological advances, today's theories of adolescent development are more likely to be supported by scientific evidence than in the past. Indeed, there has been sufficient research to allow a reassessment of the nature of adolescent development. At the same time, there is greater recognition that neither puberty nor adolescence can be understood without considering the social and cultural contexts in which young people grow and develop, including the familial and societal values, social and economic conditions, and institutions that they experience. This research has contributed the following to our understanding of adolescence:

• The adolescent years need not be troubled years.

There is now greater recognition that young people can move through the adolescent years without experiencing great trauma or getting into serious trouble; most young people do. Although adolescence can certainly be a challenging span of years, individuals negotiate it with varying degrees of difficulty, just as they do other periods of life. Moreover, when problems do arise during adolescence they should not be considered as "normal"—i.e., that the adolescent will grow out of it—nor should they be ignored (Petersen, 1988).

• Only a segment of the adolescent population is at high risk for experiencing serious problems.

Over the past 50 years, studies conducted in North America and Europe have documented that only about a quarter of the adolescent population is at high risk for, or more vulnerable to, a wide range of psychosocial problems (Carnegie Corporation of New York, 1995). These adolescents are not believed to be at increased risk because of biological or hormonal changes associated with puberty, but rather from a complex interaction among biological, environmental, and social factors. Indeed, as discussed by Anne Petersen, there is mounting evidence that most biological changes interact with a wide range of contextual, psychological, social, and environmental factors that affect behavior (Buchanan et al., 1992; Susman, 1997, see also Brooks-Gunn et al., 1994). Researchers are also concluding that behaviors associated with adolescence, including some high risk behaviors, are influenced by the social milieu (Brooks-Gunn and Reiter, 1990). Studies show that, in contrast to children and adults, the most common causes of mortality among adolescents are associated with social, environmental, and behavioral factors rather than genetic, congenital, or biological diseases. Indeed, many of today's adolescents are using alcohol and other drugs, engaging in unprotected sexual intercourse, and are both victims and perpetrators of violence, which puts them at increased risk for a wide range of developmental and health-related problems, including morbidity and mortality. It is important to note that the leading causes of morbidity and mortality among adolescents are entirely preventable. Although relatively small, a significant number of adolescents also experience morbidity and mortality associated with genetic and congenital disorders (such as cystic fibrosis, muscular dystrophy, cerebral palsy), cancer, and infectious diseases that affect their development, behavior, and well-being.

• Adolescent behavior is influenced by complex interactions between the biological and social contexts.

In the past, researchers tended to conduct research designed to examine the impact of hormones on adolescent behavior. While this work continues, there is now an appreciation for the complex reciprocal relationship and interaction between biological and social environments, and the interaction between these environments and adolescent behavior (Graber et al., 1997).

• Current understanding of adolescent development remains limited.

Although the study of adolescence is becoming more sophisticated in nature, researchers also recognize that the current knowledge base on adolescent development and behavior is quite limited. The research conducted to date has predominately been descriptive in nature, relied on cross-sectional data, and been unidimensional in focus. Indeed, few research studies have successfully considered the multiple factors that collectively influence adolescent development. As discussed by Iris Litt, there is now a growing appreciation that new research is needed, including research that employs longitudinal designs; characterizes developmental changes associated with the onset of puberty well before the age of 8; and seeks to characterize growth and development across the life span—i.e., from infancy to adolescence, young adulthood, adulthood, and the senior years. Studying these developmental stages in isolation from one another provides only a partial and incomplete picture.

• Researchers from diverse fields, including the biological, behavioral, and social sciences, have developed new techniques to study adolescent development.

Use of more rigorous research methods has improved the reliability and validity of the measurement techniques used, and consequently the ability to document the multifaceted dimensions of growth and maturation during adolescence. For example, the development of radioimmunoassay methodology in the late 1960s, and the considerable refinement of that process over the decades, have made it possible to study the hormones that control reproductive maturation. The development of neuroimaging technology in the 1970s created exciting new opportunities for studying brain development; these techniques include more sensitive, easy-to-use hormone assay technology and new brain imaging technologies, allowing insight into brain development and function. Moreover, longitudinal studies are increasingly being designed to characterize the interaction among genetic, biological, familial, environmental, social, and behavioral factors (both risk and protective in nature) among children and adolescents. For example, a valuable new source of data that has the potential to significantly advance the knowledge base of physiological and behavioral development among adolescents is the National Longitudinal Study of Adolescent Health (called Add Health). From the collection of longitudinal data, it will be possible to examine how the timing and tempo of puberty influences social and cognitive development among teenagers. This dataset will also permit analyses to examine how family-, school-and individual-level risk and protective factors are associated with adolescent health and morbidity (e.g., emotional health, violence, substance use, sexuality).

• An Increasing Number of Disciplines are Beginning to Conduct Research on Adolescent Development.

Understanding adolescent development requires answers to a number of difficult questions: how do adolescents develop physically, how do their relationships with parents and friends change, how are young people as a group viewed and treated by society, how does adolescence in our society differ from adolescence in other cultures, and how has adolescence and adolescent development changed over the past few decades. A complete understanding of adolescence, and the potential to answer these questions depends on an integrated approach, and involvement of a wide range of disciplines, including but not limited to endocrinology, psychology, sociology, psychiatry, genetics, anthropology, neuroscience, history, and economics. While each discipline offers its own view point regarding adolescence and adolescent development, the field will not be able to successfully answer these questions without integrating the contributions of different disciplines into a coherent and comprehensive viewpoint. Fortunately, studies of puberty are increasingly drawing on and therefore benefiting from the knowledge base of these diverse fields.

• Cite this Page National Research Council (US) and Institute of Medicine (US) Forum on Adolescence; Kipke MD, editor. Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research. Washington (DC): National Academies Press (US); 1999. Changes in the Study of Adolescent Development.
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Child and Adolescent Development

• First Online: 28 January 2017

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• Rosalyn H. Shute 3 &
• John D. Hogan 4  

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For school psychologists, understanding how children and adolescents develop and learn forms a backdrop to their everyday work, but the many new ‘facts’ shown by empirical studies can be difficult to absorb; nor do they make sense unless brought together within theoretical frameworks that help to guide practice. In this chapter, we explore the idea that child and adolescent development is a moveable feast, across both time and place. This is aimed at providing a helpful perspective for considering the many texts and papers that do focus on ‘facts’. We outline how our understanding of children’s development has evolved as various schools of thought have emerged. While many of the traditional theories continue to provide useful educational, remedial and therapeutic frameworks, there is also a need to take a more critical approach that supports multiple interpretations of human activity and development. With this in mind, we re-visit the idea of norms and milestones, consider the importance of context, reflect on some implications of psychology’s current biological zeitgeist and note a growing movement promoting the idea that we should be listening more seriously to children’s own voices.

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Shute, R.H., Hogan, J.D. (2017). Child and Adolescent Development. In: Thielking, M., Terjesen, M. (eds) Handbook of Australian School Psychology. Springer, Cham. https://doi.org/10.1007/978-3-319-45166-4_4

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Child and Adolescent Development for Educators

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T1 - Child and Adolescent Development for Educators

AU - Bergin, Christi Crosby

AU - Bergin, David Allen

AU - Walker, Sue

AU - Daniel, Graham

AU - Fenton, Angela

AU - Subban, Pearl

N2 - Child and Adolescent Development for Educators covers development from early childhood through high school. This text provides authentic, research-based strategies and guidelines for the classroom, helping future teachers to create an environment that promotes optimal development in children.The authors apply child development concepts to topics of high interest and relevance to teachers, including classroom behaviour management, constructivism, social-emotional development, and many others. The text combines core theory with practical implications for educational contexts, and shows how child development links to the Australian Professional Standards for Graduate Teachers. Case studies and real-world vignettes illustrate concepts, while research, including the Longitudinal Study of Australian Children, and Longitudinal Study of Indigenous children, bridges the distance between research and the classroom.

AB - Child and Adolescent Development for Educators covers development from early childhood through high school. This text provides authentic, research-based strategies and guidelines for the classroom, helping future teachers to create an environment that promotes optimal development in children.The authors apply child development concepts to topics of high interest and relevance to teachers, including classroom behaviour management, constructivism, social-emotional development, and many others. The text combines core theory with practical implications for educational contexts, and shows how child development links to the Australian Professional Standards for Graduate Teachers. Case studies and real-world vignettes illustrate concepts, while research, including the Longitudinal Study of Australian Children, and Longitudinal Study of Indigenous children, bridges the distance between research and the classroom.

SN - 9780170388665

BT - Child and Adolescent Development for Educators

PB - Cengage Learning

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Ecological Influences on Child and Adolescent Development: Evidence from a Philippine Birth Cohort

The largest number of children and young people in history are alive today, so the costs of them failing to realise their potential for development are high. Most live in low-income and lower-middle-income countries (LLMICs), where they are vulnerable to risks that may compromise their development. Yet many risk factors in LLMICs are not well understood. Moreover, recent studies suggest that in addition to the critical first 1,000 days there are several key periods of development in later childhood and adolescence which have received comparatively little research attention. This work responds to the gaps in the evidence, examining the influence of exposure to risks in the physical and social environment on health, education and development outcomes in a birth cohort of children from the Philippines. The first chapter provides a brief introduction to the theoretical and empirical evidence on the risks children face in LLMICs as well as a description of the Philippine country context and the birth cohort. The second chapter tests the associations between infant exposure to sanitation risks and subsequent school survival. The third chapter investigates the effects of housing instability in early to middle childhood on cognitive performance at 11 years of age. And, the fourth chapter examines the links between forms of social marginalisation and adolescent mental health and wellbeing. This work’s findings suggest infant exposure to faecal contamination in the home environment shortens the overall length of time children later spend at school. Preprimary-school age children appear to be at risk of developmental deficits and/or delays as a result of changes to their neighbourhood environment. And, adolescents who are excluded or become disengaged from the important socialising institutions of school and the workplace are at increased risk from developing mental disorders, while among older teens the protective effects associated with being in employment are greater than those linked to being in education.

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Psychology Research Guide

Child & adolescent development.

“Child development”, or “child and adolescent development” refers to the process of growth and maturation of the human individual from conception to adulthood. The term “adolescence” has particular connotations in particular cultural and social contexts. Child & Adolescent Psychology focuses on understanding the physical, social, psychological, and cognitive needs of young human beings. You can read more about the focus of Child & Adolescent Development on the American Psychological Association's Society of Clinical Child and Adolescent Psychology website This link opens in a new window . To find ideas for paper/research topics within child & adolescent development, visit these sites:

APA Psychology Topics This link opens in a new window (Try Bullying; Children; Education; Kids & the Media; Learning & Memory; Parenting; Teens)

Child & Adolescent Development Databases

Research in child & adolescent psychology utilizes core psychology resources, as well as resources in child & family development and sociology. You may find it helpful to search the following databases for your child & adolescent development topics or research questions, in addition to the core resources listed on the home page.

Child & Adolescent Development Subject Headings

You may find it helpful to take advantage of predefined subjects or subject headings in Shapiro Databases. These subjects are applied to articles and books by expert catalogers to help you find materials on your topic.

• Learn more about Subject Searching

Consider using databases to perform subject searches, or incorporating words from applicable subjects into your keyword searches. Here are some social psychology subjects to consider:

• adopted children
• Attachment Theory
• child abuse
• child behavior
• children of alcoholics
• cognitive development
• developmental stages
• early childhood development
• emotional development
• family relations
• middle school/junior high school/high school students
• parent child relations
• peer pressure
• personality

Child & Adolescent Development Organization Websites

• American Academy of Child and Adolescent Psychiatry (AACAP) This link opens in a new window A national professional medical association dedicated to treating and improving the quality of life for children, adolescents, and families affected by mental, behavioral, or developmental disorders.
• Child & Adolescent Development course module (UNHCR) This link opens in a new window This Resource Pack published by the United Nations High Commissioner on Refugees' Action for the Rights of Children (ARC) is a training module for those working with children and teen refugees. It covers major areas of child development acknowledging that " the concept of childhood is understood differently in different cultural and social contexts."
• Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) This link opens in a new window NICHD’s mission is to lead research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all.
• Society of Clinical Child & Adolescent Psychology (APA Division) This link opens in a new window The Society of Clinical Child and Adolescent Psychology is Division 53 of the American Psychological Association. Its purpose is to encourage the development and advancement of clinical child and adolescent psychology through integration of its scientific and professional aspects.
• Child Welfare Information Gateway - Understanding Adolescent Development This link opens in a new window United States Health & Human Services Children's Bureau Child Welfare Information Gateway has extensive resources on child & adolescent development. This link leads to their "Understanding Adolescent Development" resources page.
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Classroom research and child and adolescent development in South America.

Author information, affiliations.

• Preiss DD 1

ORCIDs linked to this article

• Calcagni E | 0000-0002-1983-3278
• Grau V | 0000-0002-4487-838X
• Preiss DD | 0000-0002-4646-5060

New Directions for Child and Adolescent Development , 01 Jan 2015 , 2015(147): 85-92 https://doi.org/10.1002/cad.20093   PMID: 25732019 

Abstract 

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Read article at publisher's site: https://doi.org/10.1002/cad.20093

References 

Articles referenced by this article (25)

Title not supplied

Reproducing racism: schooling and race in highland bolivia.

Journal of Race and Education 2004

Aulas en Paz: A multi-component program for the promotion of peaceful relationships and citizenship competencies

Conflict Resolution Quarterly 2007

Los diálogos construidos y los contenidos elaborados en clases dedicadas a la comprensión de textos, en aulas chilenas [Constructed dialogues and elaborated contents in lessons devoted to text comprehension in Chilean classrooms]

Psicologia Educativa 2013

Blackness, identity and schooling in Esmeraldas, Ecuador

Race, Ethnicity and Education 2007

Science teaching and argumentation: One-sided versus dialectical argumentation in Chilean middle school science lessons

International Journal of Science Education 2014

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Perceived discrimination and contextual problems among children and adolescents in northern chile..

Flores J , Caqueo-Urízar A , Quintana L , Urzúa A , Irarrázaval M

PLoS One , 16(2):e0246998, 19 Feb 2021

Cited by: 2 articles | PMID: 33606801 | PMCID: PMC7894936

What Do We Know About the Development of Creativity in South America?

Preiss DD , Grau V , Ortiz D , Bernardino M

New Dir Child Adolesc Dev , 2016(152):85-97, 01 Jun 2016

Cited by: 0 articles | PMID: 27254829

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Developmental psychopathology in adolescence: findings from a Swiss study--the NAPE Lecture 2005

Affiliation.

• 1 Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland. [email protected]
• PMID: 16390363
• DOI: 10.1111/j.1600-0447.2005.00706.x

Objective: Presentations of selective findings coming from the Zurich Adolescent Psychology and Psychopathology Study with two major aims: i) the study of the prevalence, course, and correlates of mental disorders in adolescence, and ii) the study of the determinants and processes of mental disorders in adolescence.

Method: A representative sample of n = 1964 children and adolescents was studied in the canton of Zurich in 1994. Additional waves of data collection took place in 1997 and 2000/2001. Mean ages at these three assessments were 13, 16, and 20 years. Each wave contained a two-stage procedure of assessment with screening by questionnaires and consecutive interviewing. The main constructs used were general and specific measures of psychopathology, life events, coping styles, self-related cognitions, and quality of the social network.

Results: Prevalence rates of any mental disorder in school-age at the time of assessment was 22.5% fitting into a transcultural range of 18-26% based on DSM-III-R criteria. Furthermore, the derivation and validation of a four-group adolescent drinker typology was demonstrated. Additionally, the prevalence and continuity of functional-somatic symptoms from adolescence to young adulthood was shown. Another piece of the research tested for the identification of risk, compensatory, vulnerability, and protective factors influencing behaviour problems and found remarkably different frequencies across the four types of moderating factors.

Conclusion: The presented findings provide further understanding of the developmental psychology and psychopathology of adolescence and the service, intervention, and prevention needs of this age-group.

Publication types

• Adolescent Behavior / psychology*
• Alcohol Drinking / epidemiology
• Child Development*
• Diagnostic and Statistical Manual of Mental Disorders
• Mental Disorders / diagnosis*
• Mental Disorders / epidemiology
• Mental Disorders / psychology*
• Psychological Tests
• Psychology, Adolescent*
• Somatoform Disorders / epidemiology
• Surveys and Questionnaires
• Switzerland / epidemiology

• Open access
• Published: 21 June 2023

Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

• Helena Ludwig-Walz   ORCID: orcid.org/0000-0003-1558-8241 1 ,
• Indra Dannheim   ORCID: orcid.org/0000-0002-4478-7808 2 , 3 ,
• Lisa M. Pfadenhauer   ORCID: orcid.org/0000-0001-5038-8072 4 , 5 ,
• Jörg M. Fegert   ORCID: orcid.org/0000-0001-6070-4323 6 &
• Martin Bujard   ORCID: orcid.org/0000-0002-3603-4160 1 , 7  

Child and Adolescent Psychiatry and Mental Health volume  17 , Article number:  74 ( 2023 ) Cite this article

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Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.

A registration on the ‘International Prospective Register of Systematic Reviews’ (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the ‘Risk of Bias in Non-randomized Studies of Exposure’ [ROBINS-E]) and certainty of evidence (using the ‘Grading of Recommendations Assessment, Development and Evaluation’ [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.

Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17–0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98–1.19). Increase in general anxiety symptoms was highest in the 11–15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30–0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23–0.65]) occurred.

General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11–15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented.

PROSPERO registration: CRD42022303714.

Mental disorders are important causes of disease burden among children and adolescents [ 1 , 2 ]. Even before the COVID-19 pandemic, the burden of disease study highlighted that anxiety disorders were the most prevalent condition in 2019 among young people in Europe. Among mental health conditions, such disorders represented a leading cause of years lived with disability [ 2 , 3 ]. In this regard, a link can be drawn between the non-treatment or undertreatment of anxiety disorders in childhood and adolescence and mental illnesses in adulthood, such as anxiety, depression and substance use disorders [ 4 , 5 ]. Anxiety is generally defined as feelings of concern that appear to have no obvious cause, but are sufficiently persistent and severe to affect daily life [ 6 ]. With the onset of the COVID-19 pandemic, the implementation of a broad range of public health and social measures (PHSM) [ 7 ] served to exacerbate many determinants of poor mental health. In particular, the environment of children and adolescents has been changed considerably by PHSM, which comprise school and leisure facilities closing, fewer peer interactions, changes in the family system as a result of the requirement to work from home, and quarantine orders [ 7 , 8 , 9 ]. As already known from previous studies [ 10 , 11 , 12 , 13 ], such changes can lead to serious impairments in young people’s mental health. To date, the impact of the COVID-19 pandemic on anxiety has been assessed primarily for the adult population [ 14 , 15 , 16 ] or its global prevalence for children and adolescents [ 17 , 18 , 19 ]. Existing European studies with a pre-pandemic baseline showed heterogeneous results [ 20 , 21 , 22 , 23 ]. However, a deeper understanding of changes in anxiety symptoms in the young population group is lacking, especially for the European continent.

An up-to-date examination of changes in anxiety symptoms among children and adolescents is therefore imperative and of great public health (PH) relevance in order to counteract suboptimal developments [ 2 ]. An analysis of the changes in the European continent means that the lack of an evidence base in the subgroup-stratified summary among children and adolescents can be rectified. It also allows for the use of a quasi-experimental design by analysing the impact of heterogeneous pandemic-related interventions in the European countries. Hence, the aim of this systematic review and meta-analysis is to identify, critically assess, summarise, and determine the certainty of evidence (CoE) regarding the impact of the COVID-19 pandemic on anxiety among children and adolescents in Europe compared with the pre-pandemic baseline. Thereby, it aims to provide information about the relevance of pandemic-related restrictions which will contribute to the analysis and the lessons learned from the immediate restrictions taken to safeguard the population in various European countries.

This systematic review and meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) [ 24 ] statement (Additional file 1 : Table S1). Our protocol is registered on the ‘International Prospective Register of Systematic Reviews’ (PROSPERO; CRD42022303714) [ 25 ] and was published a priori [ 26 ]; any deviations from the original review protocol are presented in Additional file 1 : Table S2.

Data sources, search strategy and eligibility criteria

We searched for published articles in six electronic databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19 database [including pre-prints]), up to 18 March, 2022. Additionally, we enlarged our searches by examining previous systematic reviews and meta-analysis on the same topic, checking reference lists in included studies and searching relevant grey literature sources such as reports issued by key organisations and abstracts of relevant conferences up to 16 April, 2022; more information on the screened key organisations and conferences is provided in Additional file 1 : Table S3.

We developed the search strategy according to the Population–Exposure–Comparison–Outcome (PECO) [ 27 ] scheme and included the following key search terms: children and adolescents (population), COVID-19 (exposure) and anxiety (outcome). The availability of a pre-pandemic baseline (comparison) was assessed manually. The six tailored search strategies can be found in Additional file 1 : Table S4. The search strategy was reviewed by a search specialist using the evidence-based checklist ‘Peer Review of Electronic Search Strategies’ (PRESS) [ 28 ].

Our pre-defined eligibility criteria were equally defined according to the PECO [ 27 ] scheme:

Population: Children and adolescents ≤ 19 years, living in the WHO European region [ 29 ].

Exposure: Participation in survey during the COVID-19 pandemic.

Comparison: Pre-pandemic baseline.

Primary outcomes: Measurements of general anxiety symptoms or clinically relevant anxiety rates; no secondary outcomes were considered.

We excluded studies undertaken in children and adolescents with pre-existing psychiatric diagnoses. No limits regarding language and effect measurement were applied, however our search strategy was designed and run in English. Publications drawing upon the same study population and measurement time points were included as one item. When measurement time points varied during the COVID-19 pandemic, each measurement time point was considered individually.

Selection process and data extraction

After deduplication, two reviewers (HLW, ID) used the recommended EPPI reviewer software [ 30 ] to independently screen first titles and abstracts, and second full texts, in accordance with the above eligibility criteria. Disagreements or uncertainty about eligibility were resolved through discussion. Reasons for exclusion after full text screening were recorded and are reported in a separate table (Additional file 1 : Table S5).

Further, two reviewers (HLW, ID) used piloted extraction forms to independently extract data from one third of the published studies and unpublished data requested from study authors. Remaining data extraction was completed by one reviewer (HLW) and verified by the other (ID). Differences in data extraction were discussed and resolved between the two reviewers. Our data extraction forms, in accordance with a former systematic review [ 31 ], included the following items: study information (first author, year of publication, country, study type), population and setting (sample size, % female, age of CA), COVID-19 determinants (time point of data measurement), pre-pandemic baseline (time point of data measurement, link between pre-pandemic population and the population during the pandemic) and outcomes (type of outcome, diagnostic instrument, psychometric properties of the diagnostic instrument, symptom reporter). We defined general anxiety symptoms and clinically relevant anxiety rates as primary outcomes. General self-reported measurements of anxiety were summarised as general anxiety symptoms. Since the measurement instruments and scales used varied considerably, the measurement data was standardised to standardised mean difference (SMD) with a 95% confidence interval (CI); this standardisation is also recommended by the Cochrane Handbook [ 32 ]. Measurements with a clinical cut-off or with a clinical diagnostic (International Statistical Classification of Diseases and Related Health Problems [ICD]) were summarised as clinically relevant anxiety rates and reported as odds ratio (OR) with a 95% CI. To describe PHSM restrictions in the measurement time frame of the studies and make them comparable, we used the Oxford COVID-19 Stringency Index [ 8 ] and the School Closure Index [ 8 ] as indicators. The Oxford COVID-19 Stringency Index consists of nine metrics including school closures, workplace closures and stay-at-home requirements. The index ranges from 0 (no restrictions) to 100 (most stringent restrictions) and was validated [ 8 ]. In accordance with the COVIDSurg Collaborative [ 33 ], we defined three categories: light restrictions (index < 20), moderate lockdowns (index 20–60) and full lockdowns (index > 60). The School Closure Index represents the handling of school closures and is an incorporated measurement in the Oxford COVID-19 Stringency Index, which was considered separately in our analyses. The index ranges from 0 to 3: 0 describes no restrictions; 1 contains recommended closure or all schools open with alterations resulting in significant differences compared with non-COVID-19 operations; 2 involves closure (only some levels or categories, e.g. just high school, or just public schools); and 3 requires closures at all levels [ 8 ]. We defined the cut-offs as ‘no or few alterations compared with a pre-COVID-19 situation’ (index < 2) and ‘partial or full school closure’ (index ≥ 2) [ 31 ]. We contacted nearly all study authors and asked to provide further unpublished data on age or gender-stratified data.

Risk of Bias assessment

Three reviewers (HLW, LMP, ID) independently assessed the risk of bias (RoB) in teams of two using the ‘Risk of Bias in Non-randomized Studies of Exposure’ (ROBINS-E) instrument [ 34 ]. For each study, the seven bias domains and a whole RoB assessment was revealed as either low, some concerns, high RoB, or very high RoB [ 34 ].

Data synthesis and statistical analyses

For the meta-analysis, we pooled effect estimates for general anxiety symptoms and clinically relevant anxiety rates in total and analysed different subgroups: gender (female/male), age (11–15, 16–19 years), Oxford Stringency Index (> 60/ ≤ 60) [ 8 ] and School Closure Index (≥ 2/ < 2) [ 8 ]. We used, where possible, results from adjusted analysis for pooling. If necessary, dichotomous data were transferred to SMD, using the formula recommended by Chinn [ 35 ]. Where multiple pre-pandemic measurements were available, the last measurement was used for calculation purposes. We excluded measurements, with combined anxiety/depression scores, from the meta-analysis. Where parent and self-reported data were presented [ 36 ], we gave preference to the self-reported data. Furthermore, within the meta-analysis, we grouped the studies according to their RoB rating; low/some concerns (= low) RoB studies and high RoB/very high RoB (= high) RoB studies were summarised both separately and in total. In particular, the pooled effect of the low RoB studies was taken for further interpretation. We used Review Manager 5.4.1 [ 37 ] and R Studio 4.2.1 [ 38 ] for data entry, statistical analysis, and graph creation. In all meta-analyses, random-effect models and the inverse-variance method with the ‘DerSimonian and Laird’ approach were used.

We investigated heterogeneity by using visual inspection of the forest plots as well as the Chi 2 test and I 2 index [ 39 ]. If I 2  > 50%, substantial heterogeneity was presumed. We conducted sensitivity analyses and meta-regression (if ≥ 10 studies per examined variable) to explain substantial heterogeneity [ 40 ]. Publication bias was analysed by visually interpreting funnel plots for signs of asymmetry [ 41 ] and statistically by calculating the Egger’s test (if ≥ 10 studies) [ 42 ].

Certainty of evidence

We assessed the overall CoE for each outcome using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) system and presented it along with the main findings of the review in a ‘Summary of findings’ table, based on a transparent format with defined applied criteria (Additional file 1 : Table S6) and a generated evidence profile (Additional file 1 : Table S7) [ 43 ]. The GRADE tool covers five categories for downgrading (RoB, imprecision, inconsistency, indirectness, publication bias) and three categories for upgrading (magnitude of effects, dose–response relationships, impact of residual confounding). The CoE could be rated as high, moderate, low or very low.

Our electronic search identified 7,420 non-duplicate records from database searches and additional two grey literature publications. Of these, 51 studies entered full-text screening. After a comprehensive screening process, detailed in the PRISMA flow diagram (Additional file 1 : Figure S1), we included 18 studies with 22 effect measures, comprising 16 peer-reviewed studies [ 20 , 22 , 23 , 36 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], one report [ 56 ], and one pre-print [ 21 ]. Reasons for exclusion after full-text screening are described in Additional file 1 : Table S5.

Study characteristics

The characteristics of each of the studies that were included are described in Table 1 . The total population sample included data from 752,532 pre-pandemic and 763,582 pandemic participants (broken down into general anxiety symptoms: 11,425 pre-pandemic and 13,387 pandemic participants; clinically relevant anxiety rates: 741,107 pre-pandemic and 750,195 pandemic participants). Studies were carried out in a range of countries: four in Germany [ 21 , 44 , 45 , 56 ], four in the United Kingdom [ 22 , 23 , 36 , 55 ], three in Italy [ 47 , 48 , 49 ], two in Spain [ 51 , 52 ], two in Switzerland [ 53 , 54 ], and one in Israel [ 46 ], one in the Netherlands [ 20 ], and one in Norway [ 50 ], respectively. Most of the studies measured general anxiety symptoms in spring/summer 2020 (14 effect measures) [ 20 , 21 , 22 , 23 , 36 , 45 , 46 , 47 , 49 , 50 , 51 , 53 , 54 , 55 ], while two effect measurements were conducted in autumn 2020 [ 21 , 22 ] and three in winter 2020/spring 2021 [ 21 , 51 , 52 ]. Clinically relevant anxiety rates were analysed in four studies [ 44 , 45 , 48 , 56 ]. Of the included studies, 17 [ 20 , 21 , 22 , 23 , 36 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 56 ] reported data for children and adolescents over the age of 11 and 11 studies [ 20 , 36 , 44 , 45 , 47 , 48 , 49 , 51 , 54 , 55 , 56 ] for children and adolescents under the age of 11. The measurement time point was rated as ‘full lockdown’ (Oxford Stringency Index > 60) in 14 studies [ 20 , 22 , 23 , 36 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] and partial or full school closure occured in 11 studies (School Closure Index ≥ 2) [ 20 , 21 , 22 , 23 , 36 , 46 , 47 , 48 , 49 , 51 , 55 ]. In addition, 12 studies [ 20 , 21 , 22 , 23 , 36 , 44 , 45 , 47 , 49 , 53 , 55 , 56 ] provided further study data (generally unpublished gender-stratified and age-stratified data). The effect estimates of the 18 studies that were included are summarised in Additional file 1 : Table S8. The RoB assessment revealed a ‘some concerns’ rating for six studies [ 20 , 21 , 44 , 46 , 53 , 56 ], a ‘high RoB’ rating for eight studies [ 22 , 23 , 36 , 45 , 47 , 50 , 51 , 55 ] and a ‘very high RoB’ rating for four studies [ 48 , 49 , 52 , 54 ]. Detailed rating information is provided in Additional file 1 : Figure S2 (traffic-light plot) and Additional file 1 : Figure S3 (weighted-bar plot).

Meta-analysis of general anxiety symptoms

For general anxiety symptoms, 12 studies [ 20 , 21 , 22 , 23 , 36 , 45 , 46 , 48 , 49 , 52 , 53 , 55 ] were pooled and CoE was graded as ‘very low’ (Table 2 ; further information in Additional file 1 : Table S7). In a pooling of four low RoB studies with six measures, a total change of a SMD of 0.34 (95% CI, 0.17 to 0.51, I 2  = 96%; Fig.  1 ) was calculated. Following gender stratification, a SMD of 0.30 (95% CI, 0.12 to 0.49, I 2  = 90%; Additional file 1 : Figure S4) for females and 0.34 (95% CI, 0.07 to 0.60, I 2  = 95%; Additional file 1 : Figure S5) for males in low RoB studies was revealed. Age-stratified pooling was possible for the 11–15 years age category with three studies [ 20 , 21 , 53 ] and five effect measures, and for the 16–19 years age category with two studies [ 20 , 21 ] and four effect measures. For the 11–15 years age category, the total change effect estimate yielded a SMD of 0.39 (95% CI, 0.18 to 0.60, I 2  = 93%; Additional file 1 : Figure S6). Change effect estimates were also evident for females (SMD, 0.34; 95% CI, 0.19 to 0.49; I 2  = 71%; Additional file 1 : Figure S7) and males (SMD, 0.45; 95% CI, 0.15 to 0.74; I 2  = 93%; Additional file 1 : Figure S8). Pooling within the 16–19 years age category revealed a SMD of 0.24 (95% CI, -0.01 to 0.49, I 2  = 92%; Additional file 1 : Figure S9) in total, a SMD of 0.18 (95% CI, -0.01 to 0.37; I 2  = 75%; Additional file 1 : Figure S10) for females and a SMD of 0.31 (95% CI, -0.02 to 0.63; I 2  = 92%; Additional file 1 : Figure S11) for males.

Forest plot of changes in youth general anxiety symptoms comparing before and during COVID-19 pandemic. SE, standard error; SMD, standardized mean differences; RoB, risk of bias; 95%-CI, 95%-confidence interval

To estimate the extent to which the stringency of PHSM has an impact on anxiety symptoms, low RoB studies were pooled by the Oxford COVID-19 Stringency Index (> 60 vs ≤ 60) and the School Closure Index (≥ 2 and < 2). An increase in general anxiety symptoms was observed for the Oxford COVID-19 Stringency Index > 60 (SMD, 0.52; 95% CI, 0.30 to 0.73; I 2  = 96%; Fig.  2 ) and the School Closure Index ≥ 2 (SMD, 0.44; 95% CI, 0.23 to 0.65; I 2  = 96%; Fig.  3 ).

Forest plot of changes in youth general anxiety symptoms comparing Oxford Stringency Index. SE, standard error; SMD, standardized mean differences; SI, stringency index; 95%-CI, 95%-confidence interval

Forest plot of changes in youth general anxiety symptoms comparing School Closure Index. SE, standard error; SMD, standardized mean differences; SL, School Closure Index; 95%-CI, 95%-confidence interval

Meta-analysis of clinically relevant anxiety rates

For clinically relevant anxiety rates, four studies [ 44 , 45 , 48 , 56 ] were pooled and CoE was graded as ‘very low’ (Table 2 ; further information in Additional file 1 : Table S7). Total change yielded an OR of 1.08 (95% CI, 0.98 to 1.19, I 2  = 82%; Fig.  4 ) in two low RoB studies [ 44 , 56 ]. Clinically relevant anxiety rates increased significantly in females in low RoB studies (OR, 1.10 [95% CI, 1.02 to 1.19], I 2  = 52%; Additional file 1 : Figure S12), but not for males (OR, 1.04 [95% CI, 0.92 to 1.17], I 2  = 76%; Additional file 1 : Figure S13).

Forest plot of changes in youth clinically relevant anxiety symptoms comparing before and during COVID-19 pandemic. OR, Odds Ratio; RoB, risk of bias; 95%-CI, 95%-confidence interval

Heterogeneity, publication bias and sensitivity analysis

As heterogeneity was substantial in all meta-analyses (I 2  > 50%), meta-regression analyses were conducted for the total population, female and male children and adolescents. In every meta-regression analysis, ‘RoB’ and ‘study design’ represent positive covariates (Additional file 1 : Tables S9-14). The covariate ‘RoB’ was addressed by the aforementioned stratification of low vs high RoB studies. Effect direction and significance did not change after removing the study with cross-sectional design. Sensitivity analyses (Additional file 1 : Table S15) revealed significant differences for study design and effect conversion. However, only one cross-sectional study and one study with converted measurements were included in the analyses. Effect direction and significance did not alter after removing these studies from meta-analyses. Visual analysis of the (contour-enhanced) funnel plots implied asymmetry (Additional file 1 : Figures S14–S19), but was discarded by applying Egger’s test (Additional file 1 : Table S16).

This systematic review and meta-analysis provides insights into the changes in general anxiety symptoms and clinically relevant anxiety rates in European children and adolescents after the onset of the COVID-19 pandemic when compared with the pre-pandemic baseline. We included 18 studies that assessed changes in over 750,000 children and adolescents (for several measurement points) across Europe. The pooled effect estimates of low RoB studies revealed an increase in general anxiety symptoms overall, and particularly for males in the 11–15 years age category. A significant increase in clinically relevant anxiety rates was also observed among female children and adolescents.

Considering the various different restriction policies in European countries, this systematic review and meta-analysis is the first that assessed the association between PHSM and higher general anxiety symptoms. For children above six years of age, school closures have been a major disruptor as these measures radically changed their life [ 9 ]. Instead of having social contact five days a week, often for six or eight hours a day with their class, peers and friends, they were homebound and unable to socialise properly. These full or partial school closures affected approximately 105 million pupils and students in Europe [ 57 ]. Our meta-analyses revealed particularly high general anxiety symptoms during periods of school closure (SMD, 0.44; 95% CI, 0.23 to 0.65) and other restriction measures (SMD, 0.52; 95% CI, 0.30 to 0.73); these effect increases outlined a potential impact of school closures and PHSM on anxiety symptoms. However, the evidence rating of "very low" have to be considered here; therefore, further reseach is needed. Both effect estimates were higher than in a previous meta-analysis on depression [ 31 ]. As social anxiety can be reduced through exposure to social interactions, the non-exposure to social contacts and social challenges in the school environment as a result of PHSM may explain the stronger correlation with the symptomatology. Further research will allow a comparison of the reduction in anxiety symptoms between subgroups and countries following the acute pandemic phase. Our results suggest that the higher association with restrictive measures could lead to a more rapid reduction in symptoms once life returns to normal. Nevertheless, social exclusion of children and adolescents during the pandemic could lead to life-long mental and physical health consequences [ 3 , 58 , 59 ]. However, a clearcut separation of the effects on anxiety due to school closure from those due to other pandemic related restrictions—like worries about (elderly) relatives, fear of long-lasting health effects (long COVID), and also closure of recreational and sports facilities—was not possible. This limitation was already found in a previous review [ 19 ]. Therefore, our results must be interpreted indicative regarding the possible drivers for the increased anxiety.

Regarding different subgroups, our analyses first showed strong differences between studies with low and high RoB. While the increase in general anxiety symptoms is clearly evident for studies with a low RoB, the pooling effects of high RoB studies were indistinct and non-significant. The heterogeneous evidence in literature can partly be attributed to the different quality of existing studies; this underlines the importance of strictly assessing the RoB. Second, age-specific analyses found considerably higher effect estimates for children and adolescents aged 11–15 years, in particular among males, but lower and more imprecise estimates for those aged 16–19 years. Taking into account the fact that the risk of anxiety disorders among children aged 10–14 years had already been reported as being high three decades before the COVID-19 pandemic [ 2 ], our findings showed that this age group was also more vulnerable to increases during the COVID-19 pandemic. The imprecise results for general anxiety symptoms among males in the 16–19 year age category are in contrast to findings on depression [ 31 ]. This underlines the necessity to differentiate between different mental health diagnoses in specific age groups in the COVID-19 pandemic. Third, for clinically relevant anxiety rates, the pooled associations were based on two low RoB studies from Germany and should be interpreted with caution; further empirical evidence is needed here.

This paper has strong implications for both policy and clinical practice. Policy-makers should consider the unintended consequences before imposing PHSM such as school closures on the mental health of children and adolescents. Psychiatrists, psychotherapists and other public health experts for children and adolescents should therefore be included in pandemic crisis task forces [ 60 , 61 ]. The increase in general anxiety symptoms and the variation between specific groups and countries requires children and adolescents to be closely monitored over the next few years. This monitoring should cover a broad range of age groups, similar to the recommendation of the U.S. Preventive Services Task Force to screen all children and adolescents aged 8–18, regardless of whether they have symptoms [ 62 ]. Based on our study, children and adolescents born in 2005 to 2010 (aged 11–15 years in 2020 to 2021) should be monitored henceforth. While our study indicates a strong need for anxiety disorder therapies (like previous research for depression symptoms [ 31 ]), these professionals were understaffed even before the pandemic [ 6 ]. Policy makers should therefore strengthen availability and capacity of these professional groups.

Screening and adequate diagnoses are important for identifying children and adolescents with anxiety disorders and the need for therapy. The gap between studies measuring general anxiety symptoms and those measuring clinically relevant anxiety rates in our systematic review might indicate a lack of clinical evidence and diagnoses. Parents, teachers, health care professionals and sports trainers should be made aware of risk factors and symptoms of anxiety disorders as well as mental health services. The negative consequences in later life of a failure to address anxiety symptoms on children and adolescents are well documented [ 3 , 58 , 59 ]. Moreover, even before the COVID-19 pandemic, anxiety and depression disorders were two of the top five causes of overall disease burden for children and adolescents in Europe, and suicide was a leading cause of death among 10–19-year-olds in the WHO European region [ 3 ]. It is therefore important to implement evidence-based interventions that can help address mental health issues in children. Targeted interventions and longer programmes in particular seemed to be more effective [ 3 ]. In addition, protective factors should be communicated and supported; including parent–child dialogue [ 63 ], a predictable home environment [ 64 ], peer-to-peer social contact [ 65 ] and physical activity [ 66 ]. Further, increased resilience among child and adolescents could be a predictor of fewer anxiety symptoms [ 67 , 68 ].

There are several research gaps regarding anxiety symptoms in the COVID-19 pandemic in Europe, including evidence for children aged below 10 years, differentiation by social status or education, and clinically relevant anxiety rates. Generally, there are only a very small number of studies on anxiety with a pre-pandemic baseline in Europe, although no such studies were able to be included for Eastern European countries and hardly any evidence from southern Europe. To improve this, representative longitudinal cohort or panel studies on CA should be conducted in all European countries so as to have a pre-crisis baseline and to monitor changes over time. Such a cohort or panel should include validated anxiety measures for general symptoms and for a clinically relevant cut-off, as well as demographic, socioeconomic and health-related confounders. These criteria are necessary in order to reduce the RoB and to allow subgroup-specific analyses.

Strength and limitations

There are several limitations to this review. First, RoB was high for 12 studies (66% of the studies included), mainly based on bias due to participant selection, missing data and insufficient adjustment of important confounders. This limitation was addressed by downgrading for RoB in GRADE and we stratified our meta-analyses by RoB. Second, the instruments that were used differed greatly in their scales. To unify them, we transformed the effect estimates to SMD or OR. Third, there was a high level of heterogeneity in the meta-analyses (I 2  > 50%), which we tried to explain by conducting meta-regression analyses. Fourth, no country pooling and visualisation over time were possible due to the low study quality. There were only a small number of available studies within our strict inclusion criteria with age-group-specific data. Fifth, there is a lack of longitudinal studies. Sixth, more subgroup analyses were not feasible. Seventh, the Oxford Stringency Index [ 8 ] and the School Closure Index [ 8 ] were used as proxies for PHSM and cannot cover all facets of the COVID-19 pandemic.

The strengths of this review are that it largely follows the methodological guidelines recommended by the Cochrane Handbook for systematic reviews [ 32 ], such as systematic search in several databases with a peer-reviewed search strategy and consideration of pre-prints, grey literature, and conference abstracts. In addition, literature screening, data extraction and RoB rating were performed independently and unpublished data was requested from study authors. In addition, the assessment of the RoB and the CoE was conducted using recommended tools. Thus, an assessment of evidence based on high quality studies was possible, allowing contradictory findings from previous studies to be properly interpreted.

This systematic review and meta-analysis showed an increase in general anxiety symptoms among European children and adolescents during the first two years of the COVID-19 pandemics compared with a pre-pandemic baseline. The 11–15 years male age group was particularly affected. Social distancing policies implemented in European countries, and in particular school closures, might be associated with a considerable increase in the effect of general anxiety symptoms. Therefore, school closures should be implemented only with the greatest caution and with consideration of the evidence available regarding the mental health of children and adolescents. At present, the need is huge to monitor anxiety symptoms in children and adolescents on a long-term basis and to identify which of the 105 million children and adolescents in Europe have disorders that require professional management and treatment. Due to long-term consequences of anxiety disorders and the risk of suicidality, those affected have to be clinically addressed through early identification and therapy.

Availability of data and materials

All data are included in the manuscript and appendix.

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We would like to acknowledge Dr Sabrina Schlesinger (Head of Research Group Systematic Reviews; German Diabetes Center) for her peer-review of the search strategy according to the Peer Review of Electronic Search Strategies (PRESS) Evidence-Based Checklist.

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HLW and MB formulated the research question, with clinical feedback from JMF. All authors contributed to the study concept and design. HLW and ID screened titles, abstracts, full text and extracted data. HLW, LMP and ID assessed risk of bias. HLW and LMP conducted the GRADE assessment. HLW and MB prepared the first draft of the manuscript. HLW and ID accessed and verified all data. The corresponding author had final responsibility for deciding to submit for publication. All authors read and approved the final manuscript.

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Dr Lisa M. Pfadenhauer (last five years): Co-author of the Cochrane reviews ‘Measures implemented in the school setting to contain the COVID‐19 pandemic: a rapid scoping review’, ‘Measures implemented in the school setting to contain the COVID‐19 pandemic’ and ‘Unintended consequences of measures implemented in the school setting to contain the COVID‐19 pandemic: a scoping review’. Prof Dr Martin Bujard (last five years): Research funding from European Union and BMBF (German Ministry of Education and Research). Travel grants and honoraria from universities, federal and state parliaments, federal and state ministries, Evangelical-Lutheran Church, Federal Agency for Civic Education. Consultant for BMFSFJ (Federal Ministry of Family, Senior Citizens, Women and Youth). Every grant and every honorarium were declared to the law office of the Federal Institute for Population Research (BiB). Prof Dr Jörg M. Fegert (last five years): Research funding from European Union, BMG (Federal Ministry of Health), BMBF (Federal Ministry of Education and Research), BMFSFJ (Federal Ministry of Family, Senior Citizens, Women and Youth), DFG (German Research Foundation), G-BA Innovation Fund, State Ministries of Baden-Württemberg and Saarland, State Foundation Baden-Württemberg, Porticus Foundation, Evangelical-Lutheran Church in Württemberg. Travel grants, honoraria, sponsorship for conferences and medical educational purposes from APK, Adenauer- and Ebertstiftung, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, professional associations, universities and federal and state ministries. Consultant for APK, federal and state ministries. No industry-sponsored lecture series, no shareholdings, no participation in pharmaceutical companies. Every grant and every honorarium were declared to the law office of the University Hospital Ulm. No other disclosures were reported.

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Ludwig-Walz, H., Dannheim, I., Pfadenhauer, L.M. et al. Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 17 , 74 (2023). https://doi.org/10.1186/s13034-023-00612-z

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Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure

• Lauren Gillis 1 ,
• Grant Tomkinson 1 ,
• Timothy Olds 1 ,
• Carla Moreira 2 ,
• Candice Christie 3 ,
• Claudio Nigg 4 ,
• Ester Cerin 5 ,
• Esther Van Sluijs 6 ,
• Gareth Stratton 7 ,
• Ian Janssen 8 ,
• Jeremy Dorovolomo 9 ,
• John J Reilly 10 ,
• Jorge Mota 2 ,
• Kashef Zayed 11 ,
• Kent Kawalski 12 ,
• Lars Bo Andersen 13 ,
• Manuel Carrizosa 14 ,
• Mark Tremblay 15 ,
• Michael Chia 16 ,
• Mike Hamlin 17 ,
• Non Eleri Thomas 18 ,
• Ralph Maddison 19 ,
• Stuart Biddle 20 ,
• Trish Gorely 21 ,
• Vincent Onywera 22 &
• Willem Van Mechelen 23  

International Journal of Behavioral Nutrition and Physical Activity volume  10 , Article number:  112 ( 2013 ) Cite this article

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The quantity and quality of studies in child and adolescent physical activity and sedentary behaviour have rapidly increased, but research directions are often pursued in a reactive and uncoordinated manner.

To arrive at an international consensus on research priorities in the area of child and adolescent physical activity and sedentary behaviour.

Two independent panels, each consisting of 12 experts, undertook three rounds of a Delphi methodology. The Delphi methodology required experts to anonymously answer questions put forward by the researchers with feedback provided between each round.

The primary outcome of the study was a ranked set of 29 research priorities that aimed to be applicable for the next 10 years. The top three ranked priorities were: developing effective and sustainable interventions to increase children’s physical activity long-term; policy and/or environmental change and their influence on children’s physical activity and sedentary behaviour; and prospective, longitudinal studies of the independent effects of physical activity and sedentary behaviour on health.

Conclusions

These research priorities can help to guide decisions on future research directions.

Recent research has shown that both physical activity and sedentary behaviour are associated with a wide range of current and future health outcomes [ 1 – 3 ]. In fact, physical activity and sedentary behaviour are two independent and not mutually exclusive behaviours with different effects on health outcomes [ 4 ]. In the short term, physical activity has been shown to be moderately and positively associated with bone health, aerobic fitness, blood lipid levels, self-esteem, mental activity and fundamental movement skills in children and adolescents [ 1 – 3 , 5 ]. In the long term, both physical activity and sedentary behaviour have been identified as major, independent, modifiable risk factors for mortality and morbidity from many chronic, non-communicable and potentially preventable diseases [ 6 – 9 ]. New evidence also suggests that the relation between sedentary behaviour and all-cause end cardiovascular disease mortality is independent of physical activity levels [ 7 ].

Chronic diseases place a large economic burden on health services and impose significant costs on society (e.g. premature death, underappreciated economic effects and greater reliance on treatment) [ 8 ]. Although the ill effects of chronic disease largely manifest in adulthood, it is increasingly understood that the development typically begins in childhood or adolescence [ 9 ]. Therefore, physical activity levels and sedentary behaviour performed in the early years could potentially influence the development of disease later on in life.

At present, a large quantity of research is being conducted into the physical activity and sedentary behaviour of children, yet the research community remains challenged to provide a solid evidence base [ 10 ]. This is in part due to a lack of international research collaboration and a high degree of study repetition. The aim of this study therefore was to arrive at a set of international research priorities for physical activity and sedentary behaviour to guide more meaningful and focussed research. Specifically, this study aimed to answer the following research question: “What are the most important international research issues for the next 10 years in child and adolescent physical activity and sedentary behaviour?” Agreement on research priorities may help to inform evidence-based policy, guide funding allocation, and direct research options for postgraduate students [ 11 , 12 ].

Existing literature

To identify existing evidence in this area, a systematic review of the English and non-English literature was performed using the following search terms: physical activit* OR motor activity (MeSH) OR sedentary behavio* AND child* OR adolescen* OR youth* AND research priorit* OR research agenda* OR research issue*. The databases PsychINFO (1887–), SPORTDiscus (1949–), Cochrane (1992–), CINAHL (1937–), ERIC (1966–) and PubMed (1950–) were searched in May 2012. Additional studies were also identified by contacting experts, Google searching and identifying potential studies in the reference lists of identified studies. Only four previously published papers that arrived at research priorities in child physical activity and/or sedentary behaviour were identified [ 11 , 13 – 15 ]. A working paper by Bull et al. [ 11 ] identified research priorities in physical activity with a focus on low to middle income countries. Evenson and Mota [ 13 ] highlighted research on the determinants and outcomes of physical activity and made recommendations for future study designs. Mountjoy et al. [ 15 ] identified existing gaps in physical activity research for children, with a focus on the need for greater collaboration between sport and existing programmes. The final study by Fulton et al. [ 14 ] had two aims. Firstly, the study aimed to review the current knowledge of existing methods for assessing physical activity and sedentary behaviour. Secondly, on the basis of this, the study aimed to set research priorities on the use of reliable and valid measurement tools to assess physical activity and sedentary behaviour in children aged 2–5 years.

While these studies were valuable contributions, they also had many limitations, including unsystematic participant selection, unstructured data collection procedures, and limited reporting on the process followed to arrive at the research priorities. Furthermore, the participants involved in the decision-making processes did not always represent the broader community of researchers, either from a geographical or institutional point of view. In addition, the anonymity of participants was not maintained during the consensus process. These limitations warranted a further study with an aim to arrive at a set of research priorities by employing a structured and rigorous methodology and improving reporting quality.

Methodology

Ethical approval for all aspects of the methodology was granted by the University of South Australia Human Research Ethics Committee in September 2011.

This study employed a Delphi procedure. This procedure is appropriate for research questions which cannot be answered with complete certainty, but rather by the subjective opinion of a collective group of informed experts [ 16 ]. It allowed systematic refinement of the experts’ opinions over the course of several rounds while minimising confounding factors present in other group response methods [ 17 – 20 ].

The experts who participated in the Delphi procedure were identified by a 3–step procedure. Firstly, the lead study investigators independently recommended known researchers for the study. Secondly, a lengthy and extensive search was carried out to identify potential researchers from every world region and sub-region. Identifying potential experts from these regions involved searching for staff of relevant international bodies, government departments, non-government organisations, professional organisations and educational institutions. Thirdly, following email communication with the experts who have previously been identified, new experts were referred to the study investigators.

Once participants had been identified, it was important to determine their eligibility for inclusion in the study. Thus they were assessed using pre-determined inclusion and exclusion criteria. To be eligible, a researcher had to be an author of at least one peer-reviewed scientific publication on the physical activity or sedentary behaviour of children or adolescents, and must hold (at the time of selection) a senior position in their organisation. In addition, the experts were deliberately chosen to give geographical coverage of every world region and sub-region. Relevant information was gathered from staff homepages, Scopus author searches, the Journal and Author Name Estimator ( http://www.biosemantics.org/jane/ ) and other relevant Internet searches to ascertain whether a researcher met these criteria.

Forty-six eligible experts were invited to participate, with each sent information and consent forms via email. As a whole, these participants were representative of every region and sub-region. Of those invited, 20 did not respond to the invitation, two declined to participate, and 24 returned signed consent forms. An outline of this process is illustrated in Figure  1 .

Purposive sampling process undertaken.

The 24 participating experts (17 male and 7 female) were randomly allocated to either Panel A or Panel B and assigned identification code names accordingly. Furthermore the following major institution types were represented by the selected experts; educational institutions, government organisations, non-government organisations, professional organisations and community organisations.

The Delphi procedure used three rounds [ 21 ], each consisting of data collection, data analysis and controlled feedback. The survey was administered entirely online using a Survey Gizmo questionnaire. A novel feature of this study was the use of two parallel panels of experts. The existence of an alternate panel was only made known to the participants in Round 3, when each panel was asked to rank the priorities of the other panel. This allowed quantitative comparisons to be made between each panel’s rankings of each research issue and cross-validated the rankings of research priorities developed by each panel.

To commence each round, experts were sent an email containing a direct link to the online questionnaire. Briefly, Round 1 required each expert to answer the question “What are the five most important research issues for the next 10 years in the area of child and adolescent physical activity and sedentary behaviour?” Each expert put forward five research issues which they believed were priorities in the area. They also provided a brief description of each issue and reasons why they believed the issue to be a priority. The three study investigators reviewed all issues that were provided by each panel, with common issues combined into a single issue. The experts were then fed back their panel’s list of research issues and asked to ensure that the five research issues they provided were accurately represented.

Round 2 then asked experts to “review the research issues put forward in Round 1 and rate how important they believe each issue is for global research in child and adolescent physical activity and sedentary behaviour”. Experts rated each research issue independently using a 5-point Likert scale (5 = very important, 4 = important, 3 = moderately important, 2 = of little importance and 1 = unimportant). The three study investigators then short-listed each panel’s research issues to 20 according to those with highest mean Likert scale ratings. Following this, the top 20 research issues from each panel were fed back to the experts of the relevant panels.

In Round 3, experts were first asked to “rank their panel’s top 20 research issues in order of perceived international importance in child and adolescent physical activity and sedentary behaviour over the next 10 years”. The experts were then similarly asked to rank the alternate panel’s top 20 research priorities. The data analysis procedure was as follows. Firstly, the overall sum of each panel’s rankings was calculated for Panel A and Panel B’s top 20 research issues. Secondly, the two lists of research issues were combined with common issues provided by both panels merged. This resulted in 29 unique issues. Thirdly, the experts’ individual rankings for each research issue were summed. This allowed the issues to be ranked according to the sum of Panel A and Panel B’s overall rankings for each issue. Intra-panel agreement was quantified using Spearman’s rho by creating a matrix to compare individuals’ rankings to one another within the same panel. Inter-panel agreement was also quantified using Spearman’s rho to compare the overall sum and rank for each issue between panels.

Expert demographics

All 24 experts completed the three Delphi rounds. Data was collected on the 24 experts’ geographical distributions, institutional affiliations and years worked in the study area.

As a group, the 24 experts represented every geographical region and 12 sub-regions. This geographical distribution is illustrated in Figure  2 .

Geographical distributions of participating experts. The numbers indicate the number of participating experts from that region.

In terms of institutional affiliation, twenty-three experts acknowledged they were affiliated with an educational institution, eleven were affiliated with a professional organisation, six with an international organisation, six with a non-government organisation and four with a government organisation. It was noted that due to the nature of their work, experts were often affiliated with more than one institution type.

In regards to years worked in the study area, twelve experts had worked in for greater than 16 years, five had worked for 11 to 15 years, four had worked for 6 to10 years and three had worked for less than five years.

Results from Delphi rounds

In Round 1, each expert put forward five research issues. Collectively this provided a total of 120 issues across all 24 experts, with 60 for each panel. Following qualitative reduction of overlapping issues, 26 issues from Panel A and 34 issues from Panel B, were carried forward to Round 2. On reviewing the amended list, all exerts agreed that the issues they had raised were adequately represented.

From Round 2, the mean Likert-scale ratings were used to determine the top 20 issues for each panel. For Panel A, the mean Likert-scale ratings of the top 20 issues ranged from 3.5 to 5.0, with 18 of 20 issues having a median rating of >4.0 (“important”). For Panel B, the mean Likert-scale ratings of the top 20 issues ranged from 4.0 to 4.8, with all 20 research issues having a median rating of >4.0.

In Round 3, the 20 issues from Panel A and 20 issues from Panel B were qualitatively analysed to form one list. Eleven of each panel’s top 20 research issues were common to both panels and were therefore combined, with the remaining 18 issues (nine from each panel) unique. The resultant was a set of 29 unique research issues that were then ranked in order of importance by summing Panel A and Panel B’s rankings for each issue Table  1 .

There was only weak intra-panel agreement. The mean inter-individual rho ( ± 95% CI) was 0.20 ±0.05 for Panel A and 0.13 ±0.04 for Panel B. The average standard deviation of the rankings for individual issues was 5.1 (Panel A) and 5.3 (Panel B). When Panel B ranked Panel A’s issues, the correlation was very strong ( rho ± 95% CI: 0.79 ±0.17), and when Panel A ranked Panel B’s issues, the correlation was strong ( rho ± 95% CI: 0.52 ±0.31). Figures  3 and 4 clearly illustrate the correlations for each research issue.

Agreement between Panel A’s rankings and Panel B’s rankings of Panel A’s identified issues. The line shown is the identity line.

Agreement between Panel B’s rankings and Panel A’s rankings of Panel B’s identified issues. The line shown is the identity line.

Study outcomes

The primary outcome of this study was the development of 29 international research priorities in child and adolescent physical activity and sedentary behaviour. In order for the research priorities to be useful, it is important that they be neither too general nor too specific. The research priorities in this study appear broad enough to enable them to be transferable to researchers’ specific regions and contexts.

The final set of research priorities address a broad range of areas from epidemiology, determinants and correlates, through to intervention effectiveness and translational research. Of the 29 identified research priorities, ten related directly to translational research centred on intervention design and effectiveness. These focussed on specific behaviours (active transport, screen time, sport, physical education), settings (schools, communities, whole of population), or vehicles (mass advertising, policy). Translational research, centred on intervention design and effectiveness, can potentially guide governments and stakeholders to fund interventions that are the most effective, sustainable and transferable for changing behaviours [ 7 ]. This is important because to date, the research community has not been very successful at developing interventions for children and adolescents that bring about long-term and sustained change in health behaviours [ 10 ]. In addition, little attention has been given to the importance of the intervention setting and establishing what works in what situation and with whom [ 22 ].

Nine of the research priorities had a focus on capturing and quantifying the health benefits of engaging in physical activity and limiting sedentary behaviour, These research priorities were concerned with the impact of physical activity and sedentary behaviour on obesity, cognition, and general health and well being, and on describing behavioural patterns (across the day or the life-course or in specific populations such as pre-school children). Epidemiological research was considered important to address the cause, distribution and patterns of childhood physical activity and sedentary behaviour on current and future health [ 2 , 6 , 9 , 23 ].

Six research issues related to determinants and correlates research such as psychosocial and cultural/parental factors, the impact of technology, and the importance of enjoyment and lifestyle in general. Research that focuses on the determinants and correlates of behaviours is important. This is because while many correlates appear to be intuitively obvious, at present they have mixed support from high quality research [ 3 ].

Four issues did not fit into the aforementioned categories. They were related to the theory of behaviour change, injury prevention, measurement of behaviours and the physical education in culture of movement. Objective measurement of behaviours was ranked highly and is thought to be a “necessary first step for conducting meaningful epidemiological surveillance, public health research and intervention research” [ 14 ] p.124.

Strengths and limitations

Unlike previously identified priority reports [ 11 , 13 – 15 ] this study employed a Delphi method to arrive at a more valid set of research priorities. Strengths related to the Delphi method include participant blinding, iterative data collection and controlled feedback between rounds. For example, the identities and responses of the experts were anonymised so that the identified research priorities could not be dominated by certain individuals [ 24 ]. Furthermore, the provision of controlled feedback allowed experts to individually consider their views in light of their panel’s collective opinion.

Other strengths related to the methodology were the use of criterion and purposive sampling methods. This procedure meant that all participants held a senior position in their respective organisations and had published in the study area. In addition, experts collectively represented every major world region and a wide range of discipline areas, affiliations and interests. This approach meant that the identified research issues were more likely to reflect the most important physical activity and sedentary behaviour issues facing the children and adolescents worldwide.

A novel component of this study was split-panel approach, which allowed comparisons to be made between the rankings given by the two expert panels. The experts from each panel were taken from the same population, given the same study information, answered identical online questionnaires and participated simultaneously and independently. One can therefore be confident that comparing the Round 3 rankings of Panel A and Panel B experts would provide valid measures of inter-panel agreement.

The weak intra-panel agreement was weak, which is likely a reflection of the natural variation of individual’s opinions and areas of interest within the broad study area. This weak agreement could also highlight the advantages of the methodology which retained anonymity and used an online mode of data collection. There were fewer pressures to conform to others opinions due to decreased likelihood of peer dominance and status. Evidence to reinforce confidence in the results is the strong to very strong (rho = 0.52–0.79) inter-panel agreement. While experts were invited from every United Nations sub-region (United Nations 2011), no experts from the following sub-regions took part: Southern Africa, Middle Africa, Caribbean, Eastern Europe, Australia, Central Asia and Western Asia. This was significant because many of these sub-regions are heavily involved in physical activity and sedentary behaviour research. Consequently, caution should be applied when recommending that the identified research priorities truly provide a global perspective. Nonetheless, these research priorities provide an international context from which priorities at the regional, national and local levels can be developed.

In addition the priorities were set for the broad area of child and adolescent physical activity and sedentary behaviour. Due to the generality of this topic, it may be that the research priorities are not relevant when conducting research into minority populations. For example, children and adolescents with disabilities may warrant different research issues not identified in this study.

Implications for research

We hope that the identification of a set of ranked research priorities may contribute to more co-ordinated international research. For example, research priorities can help inform post-graduate students regarding where the current evidence gaps exist. This may be especially helpful for researchers who reside in less developed or marginalised research regions. In addition, encouraging more guided research can help to conceptualise how findings can be used as a basis for policy decisions. Lastly, research priorities can help to direct valuable funding into priority areas and away from studies on over-researched or lower priority topics.

This study engaged two panels of study experts in a three-round Delphi communication procedure. The outcome of this procedure was the identification of a ranked set of 29 research priorities in child and adolescent physical activity and sedentary behaviour. For example, the top three ranked priorities were: developing effective and sustainable interventions to increase children’s physical activity long-term; policy and/or environmental change and their influence on children’s physical activity and sedentary behaviour; and prospective, longitudinal studies of the independent effects of physical activity and sedentary behaviour on health. We hope these research priorities will help inform the spectrum of future studies undertaken, guide post-graduate study choices, guide allocation of funding to priority areas and assist with policy decisions.

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Acknowledgements

The authors would like to acknowledge the Health and Use of Time Group at the University of South Australia.

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Authors and affiliations.

Health and Use of Time (HUT) Group, University of South Australia, Adelaide, South Australia, Australia

Lauren Gillis, Grant Tomkinson & Timothy Olds

Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal

Carla Moreira & Jorge Mota

Ergonomics Unit, Rhodes University, Grahamstown, South Africa

Candice Christie

Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, HI, USA

Claudio Nigg

Institute of Human Performance, The University of Hong Kong, Hong Kong, China

Ester Cerin

MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK

Esther Van Sluijs

The Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK

Gareth Stratton

School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada

Ian Janssen

University of the South Pacific, Laucala Campus, Suva, Fiji, Islands

Jeremy Dorovolomo

Physical Activity for Health Research Group, School of Psychological Sciences and Health, University of Strathclyde, Jordanhill, Glasgow, UK

John J Reilly

Department of Physical Education, Sultan Qaboos University, Muscat, Sultanate of Oman

Kashef Zayed

Physical and Health Education and Department of Psychology, School of Exercise Science, University of Victoria, Victoria, BC, Canada

Kent Kawalski

Center for Research in Childhood Health, Institute of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark

Lars Bo Andersen

Education Faculty, University of Extremadura, Avda de Elvas s/n, Badajoz, Spain

Manuel Carrizosa

Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada

Mark Tremblay

Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore

Michael Chia

Department of Social Science, Parks, Recreation, Tourism and Sport, Lincoln University, Christchurch, New Zealand

Mike Hamlin

Centre for Children and Young People's Health and Well-Being, School of Human and Health Sciences, Swansea University, Swansea, UK

Non Eleri Thomas

Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland, 1142, New Zealand

Ralph Maddison

School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, UK

Stuart Biddle

Institute of Youth Sport, School of Sport and Exercise Sciences, Loughborough University, Loughborough, LE, 11 3TU, UK

Trish Gorely

Department of Exercise, Kenyatta University, Recreation and Sport Science, Nairobi, Kenya

Vincent Onywera

Department of Public & Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands

Willem Van Mechelen

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Correspondence to Grant Tomkinson .

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The authors declare that they have no competing interests.

Authors’ contributions

The study was conceived by GT and TO. LG was primarily responsible for conducting the participant selection process and the three rounds of data collection. LG, GT and TO were each involved in data analysis. LG produced the first draft of the paper with all other authors providing sections and critically reviewing the paper. All authors approved submission.

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Gillis, L., Tomkinson, G., Olds, T. et al. Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure. Int J Behav Nutr Phys Act 10 , 112 (2013). https://doi.org/10.1186/1479-5868-10-112

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Received : 26 March 2013

Accepted : 09 September 2013

Published : 24 October 2013

DOI : https://doi.org/10.1186/1479-5868-10-112

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• Physical activity
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International Journal of Behavioral Nutrition and Physical Activity

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ORIGINAL RESEARCH article

This article is part of the research topic.

Towards a Psychophysiological Approach in Physical Activity, Exercise, and Sports-Volume III

Sports preferences in children and adolescents in psychiatric careevaluation of a new questionnaire (SPOQ) Provisionally Accepted

• 1 Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Germany
• 2 Department of Sports Psychology, Johannes Gutenberg University, Germany
• 3 Institut für Integrative Medizin, Universität Witten/Herdecke, Germany

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Introduction: As part of an exploratory and hypothesis-generating study, we developed the Sports Preference Questionnaire (SPOQ) to survey the athletic behavior of mentally ill children and adolescents, subjectively assessed physical fitness and perceived psychological effects of physical activity. Methods: In a department of child and adolescent psychiatry, we classified 313 patients (6-18 years) according to their primary psychiatric diagnosis. The patients or -in the parental version of the questionnaire -their parents reported their sport preferences on the SPOQ. As possibly influential factors, we also assessed the frequency of physical activity, the importance of a trainer, coping with everyday life through physical activity, and subjectively perceived physical fitness. Results: One in 3 patients (32.4 %) stated that they were not physically active. Patients diagnosed with eating disorders reported, on average, a notably high frequency (median of 3 h/week) and degree of coping with daily life through physical activity (median of 5 on a 6-point Likert scale). Patients with anxiety disorders and depression had the lowest selfperception of physical fitness (mean value of 3.1 or 3.7 on an interval scala from 0 to 9). The presence of a trainer was generally considered not very uniimportant, except forbut not in ADHD patients (median of 3 on a 6-point Likert scale). Conclusion: The SPOQ is sensitive for differential effects of core child and adolescent disorders as well as for main covariates influencing the complex association between physical activity and emotional and behavioral disorders in children and adolescents. Based on this pilot study, we discussed the need for an efficacy study to measure the effects of sports therapy.

Keywords: Sports Preference Questionnaire, mental disorder, Sports therapy, Psychological effect, physical activity

Received: 12 Dec 2023; Accepted: 22 Apr 2024.

Copyright: © 2024 Breido, Stumm, Jenetzky and Huss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Michael Huss, Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany

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