Inhibition, a subtests from the NEPSY® Second Edition, will be used to measure Inhibitory Control and Cognitive Flexibility which are important executive functions. Scaled scores are calculated by Pearson's NEPSY-2 machine based scoring tool.

In brief, a low Inhibition-Switching Combined Scaled Score* indicate poor Inhibitory Control and Cognitive Flexibility.

The Inhibition-Switching Combined Scaled Score integrates error rates and time (i.e., raw score Inhibition-Switching Total Errors Completion Time) with more weight given on accuracy than speed.

*Converted scaled scores have a mean of 10, a standard deviation of 3, and a range from 1-19.

Design Fluency, a subtests from the NEPSY® Second Edition, will be used to measure Executive Function including non-verbal Cognitive Flexibility.

Total raw score for 6 to 12 years old children: 0 (min.) - 70 (max.). Raw scores are converted to scaled scores* by Pearson's NEPSY-2 machine based scoring tool.

In brief, higher scores scores means better non-verbal Cognitive Flexibility and Executive Function, and vice versa.

*Converted scaled scores have a mean of 10, a standard deviation of 3, and a range from 1-19.

Inhibitory control will be measured using the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2; parent- and teacher-report) Inhibit Index. Items are converted from BRIEF to BRIEF-2 (cf. BRIEF-2 does not include additional items). Raw scores are calculated to t-scores according to the Psychological Assessment Resources' (PAR) BRIEF-2 manual. Higher scores mean worse ability to control impulses. T Scores ≥ 65 are regarded as in the clinical range.

References:

Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior rating inventory of executive function professional manual. Odessa: FL: Psychological Assessment Resources.

Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2015). Behavior Rating Inventory of Executive Function®, Second Edition (BRIEF®2). Lutz, FL: PAR Inc.

Cognitive flexibility (e.g., the ability to tolerate change and switch or alternate attention) will be measured using the BRIEF-2's Shift Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores mean worse ability to tolerate change and switch or alternate attention. T Scores ≥ 65 are regarded as in the clinical range.

Emotional control will be measured using the BRIEF-2's Emotional Control Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse emotional control. T Scores ≥ 65 are regarded as in the clinical range.

The ability to begin an activity and to independently generate ideas or problem-solving strategies will be measured using the BRIEF-2's Initiate Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse ability to initiate actions. T Scores ≥ 65 are regarded as in the clinical range.

Working memory capacity will be measured using the BRIEF-2's Working Memory Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse working memory. T Scores ≥ 65 are regarded as in the clinical range.

Ability to plan/organize will be measured using the BRIEF-2's Plan/Organize Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse ability to plan/organize. T Scores ≥ 65 are regarded as in the clinical range.

Ability to organize materials will be measured using the BRIEF-2's Organization of Materials Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse ability to organize materials. T Scores ≥ 65 are regarded as in the clinical range.

The ability to task-monitor (i.e., the ability to noticing minor errors in work output) will be measured using the BRIEF-2's Task-Monitor Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse ability to task-monitor. T Scores ≥ 65 are regarded as in the clinical range.

The ability to self-monitor (i.e., the awareness of the impact of one's own behavior on other people and outcomes) will be measured using the BRIEF-2's Self-Monitor Index. Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse ability to self-monitor. T Scores ≥ 65 are regarded as in the clinical range.

The childrens' overall executive function will be measured using the BRIEF-2's Global Executive Composite (Total Score). Items are converted from BRIEF to BRIEF-2. Raw scores are calculated to t-scores according to the PAR BRIEF-2 manual. Higher scores means worse executive function. T Scores ≥ 65 are regarded as in the clinical range.

The childrens' ability to regulate and monitor their behavior effectively will be measured using the BRIEF-2's Behavior Regulation Index (BRI). BRIEF scores are converted to BRIEF-2 scores as BRIEF-2 consists of no new items. Raw scores are calculated to T Scores according to the PAR BRIEF-2 scoring manual. Higher scores means worse behavior regulation. T Scores ≥ 65 are regarded as in the clinical range.

The childrens' ability to regulate their emotions will be measured using the BRIEF-2's Emotion Regulation Index (ERI). BRIEF scores are converted to BRIEF-2 scores as BRIEF-2 consists of no new items. Raw scores are calculated to T Scores according to the PAR BRIEF-2 scoring manual. Higher scores means worse emotion regulation. T Scores ≥ 65 are regarded as in the clinical range.

The childrens' ability to control and manage cognitive processes and problem solve effectively will be measured using the BRIEF-2's Cognitive Regulation Index (CRI). BRIEF scores are converted to BRIEF-2 scores as BRIEF-2 consists of no new items. Raw scores are calculated to T Scores according to the PAR BRIEF-2 scoring manual. Higher scores means worse cognitive regulation. T Scores ≥ 65 are regarded as in the clinical range.

Parental stress and stressful aspects of parent-child interaction will be measured by the Parenting Stress Index (PSI; parent-report).

Results by the following PSI Indexes will be reported:

• Child Subscale. Values: 47 (min.) - 235 (max.)
• Parent Subscale. Values: 54 (min.) - 270 (max.)
• Total Stress Scale. Values: 101 (min.) - 505 (max.)
• Life Stress. Values: 0 (min.) - 79 (max.)

Raw scores to percentiles calculation will be done using Psychological Assessment Resources' (PAR) PSI score sheet. The percentiles will be divided in the following categories: percentiles ≤ 19, percentiles between 20 and 50, percentiles between 51 and 84, and percentiles ≥ 85. Higher scores and percentiles means more distress and vice versa.

Stress Response in children and their mothers will be measured by Hair Cortisol Concentrations:

1st cm from the scalp of children and their mothers. Indicate hair cortisol concentrations from the last month (approximately).

The Relationships Questionnaire (RQ; Bartholomew & Horowitz, 1991) will be used to measure four attachment styles in parents. Parents are asked to rate their degree of correspondence (7-point scale) to each attachment prototype described in RQ. The minimum value is 1 ("Disagree strongly") and the maximum value is 7 ("Agree strongly") which indicate how well or poorly each attachment style corresponds to the parent's general relationship style.

The Syndrome Scale Withdrawn/Depressed from the Achenbach Systems of Empirically Based Assessment (ASEBA; Norwegian Version) for children 6-18 years by parent- and teacher-report will be used to measure withdrawn and depressed, i.e., internalizing, symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The Syndrome Scale Anxious/Depressed from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure anxious and depressed, i.e., internalizing, symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The Syndrome Scale Somatic Complaints from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure anxious and depressed, i.e., internalizing, symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The Syndrome Scale Social Problems from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure social problems. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical social problems, a t-score between 65 and 69 indicates that the child is at risk for clinical social problems, and a t-score ≥ 70 indicates clinical social problems.

The Syndrome Scale Thought Problems from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure thought problems. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical thought problems, a t-score between 65 and 69 indicates that the child is at risk for clinical thought problems, and a t-score ≥ 70 indicates clinical thought problems.

The Syndrome Scale Attention Problems from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure attention problems. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical attention problems, a t-score between 65 and 69 indicates that the child is at risk for clinical attention problems, and a t-score ≥ 70 indicates clinical attention problems.

The Syndrome Scale Rule-Breaking Behavior from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure rule-breaking behavior. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical rule-breaking behavior, a t-score between 65 and 69 indicates that the child is at risk for clinical rule-breaking behavior, and a t-score ≥ 70 indicates clinical rule-breaking behavior.

The Syndrome Scale Aggressive Behavior from the ASEBA (6-18 years by parent- and teacher-report) will be used to measure aggressive behavior. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical aggressive behavior, a t-score between 65 and 69 indicates that the child is at risk for clinical aggressive behavior, and a t-score ≥ 70 indicates clinical aggressive behavior.

Internalizing problems will be assessed with parent- and teacher-report using the ASEBA for children 6-18 years. The Internalizing Problems Scale Score combine the the following Syndrome Scales Scores: Anxious/Depressed, Withdrawn/Depressed, and Somatic Complaints. Higher scores means worse symptom level. T-scores from the Internalizing Problems Scale will be calculated using a computer based program. A t-score ≤ 59 indicates non-clinical symptoms, a t-score between 60 and 64 indicates that the child is at risk for problem behaviors, and a t-score ≥ 65 indicates clinical symptoms.

Externalizing problems will be assessed with parent- and teacher-report using the ASEBA for children 6-18 years. The Externalizing Problems Scale Score combine the the following Syndrome Scales Scores: Rule-Breaking Behavior and Aggressive Behavior. T-scores from the Externalizing Problems Scale will be calculated using a computer based program. Higher scores means worse symptom level. A t-score ≤ 59 indicates non-clinical symptoms, a t-score between 60 and 64 indicates that the child is at risk for problem behaviors, and a t-score ≥ 65 indicates clinical symptoms.

Total behavior and emotional problems will be assessed with parent- and teacher-report using the ASEBA for children 6-18 years. The Total Problems Scale Score combine the total Syndrome Scales Scores. This includes the following syndrome scales in addition to those included in the Internalizing and Externalizing Problems Scales: Social Problems, Thought Problems, and Attention Problems. T-scores from the Total Problems Scale will be calculated using a computer based program. Higher scores means worse symptom level. A t-score ≤ 59 indicates non-clinical symptoms, a t-score between 60 and 64 indicates that the child is at risk for problem behaviors, and a t-score ≥ 65 indicates clinical symptoms.

The DSM-Oriented Scale Affective Problems of the ASEBA for children 6-18 years by parent- and teacher-report will be used to measure affective symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms. The DSM-5 oriented symptoms by ASEBA includes:

The DSM-Oriented Scale Anxiety Problems of the ASEBA (6-18 years by parent- and teacher-report) will be used to measure anxiety symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The DSM-Oriented Scale Somatic Problems of the ASEBA (6-18 years by parent- and teacher-report) will be used to measure somatic problems. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The DSM-Oriented Scale Attention Deficit/Hyperactivity Problems of the ASEBA (6-18 years by parent- and teacher-report) will be used to measure attention deficit/hyperactivity symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The DSM-Oriented Scale Oppositional Defiant Problems of the ASEBA (6-18 years by parent- and teacher-report) will be used to measure oppositional defiant Symptoms. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The DSM-Oriented Scale Conduct Problems of the ASEBA (6-18 years by parent- and teacher-report) will be used to measure conduct problems. Raw scores will be calculated to T-scores using a computer based program. Higher scores means worse symptom level. A t-score ≤ 64 indicates non-clinical symptoms, a t-score between 65 and 69 indicates that the child is at risk for clinical symptoms, and a t-score ≥ 70 indicates clinical symptoms.

The following items of the ASEBA for children 6-18 years by parent- and teacher report will be used to measure irritability symptoms on a continous scale: 86. Stubborn, Sullen, or Irritable, 87. Sudden mood changes, and 95. Temper tantrums or hot temper. Each item is rated on the same 0-1-2 Likert scale: 0 = Not True, 1 = Somewhat or Sometimes True, 2 = Very True or Often True. Minimum value is 0 and Maximum value is 6. Higher scores means more irritability and vice versa.

Degree of emotional and behavioral dysregulation is computed by summing up the T-scores for the syndrome scales Anxiety/Depression, Attention Problems, and Aggression Problems (AAA profile) in ASEBA. Higher t-score means higher degree of dysregulation and vice versa. T scores equal to or above 210 means severe dysregulation.

Children's Global Assessment Scale is a numeric scale (ranging from 1 to 100) measuring the general functioning of children. Higher scores means better functioning and vice versa.

Children meeting criteria for Disruptive Mood Dysregulation Disorder (DMDD) at baseline will be examined after 6 months using the K-SADS screening and additional interview for DMDD to check if they still meet criteria for DMDD.

All participants will be examined after 12 months using the K-SADS to check if they still meet the criteria for a diagnosis.

The same scales from the ASEBA as examined at baseline will be used similarly to measure symptom levels after 12 months.

Items examination of NEPSY-2 Affect Recognition targeting face-emotion interpretation bias.