Mindfulness Program for Adolescents With 22q11DS

Parent-adolescent pairs (N=60) will be recruited to participate in a randomized controlled trial. Consent, permission, and/or assent will be sought prior to participation in the study. Participant pairs will be randomized into one of two study arms: intervention and wait-list control. All participants will complete a web-based pre-test questionnaire. Adolescents and parents in the intervention group will then receive access to the Aware Program for four weeks. Approximately 4-5 weeks after completing the pre-test questionnaire, all participants will complete a web-based post-test questionnaire (the post-test for the intervention group will include Consumer Satisfaction questions about the program). Adolescents and parents in the wait-list control group will then have the option of reviewing the Aware Program and will receive access for four weeks. After approximately four weeks, they will have the opportunity to complete the Consumer Satisfaction Questionnaire about the program.

• Aware Program (Behavioral): The program includes interactive, multimedia lessons for adolescent participants to learn, practice, and apply different mindfulness skills. Parent-adolescent pairs will have the option to subscribe to a mobile messaging service that includes progress reminders, encouragement, and practice content. Parent participants also have access to online resources to support and monitor their teen's use of the program.

Primary outcomes

• Change From Baseline in Adolescents' Coping Skills [Baseline and Week 4]: Adolescents will be asked to respond to 34 questions (e.g., Try to think of different ways to solve it; 1 = Never; 5 = Always) that assess their coping in response to stressors across 5 domains: Seeking Social Support, Problem Solving, Distancing, Externalizing, and Internalizing. Three items related to mindfulness skills will be included as a mindfulness subscale. Responses will be averaged across each domain and the minimum scale score is 1 and the maximum scale score is 5. Higher scores indicate greater use of the coping strategy.
• Change From Baseline in Adolescents' Emotion Regulation [Baseline and Week 4]: Adolescents will be asked to respond to 10 questions (e.g., I keep my emotions to myself; 1 = Strongly disagree; 7 = Strongly agree) that assess their use of two emotion regulation strategies: Cognitive Reappraisal and Suppression. Responses will be averaged across each strategy and the minimum scale is 1 and the maximum scale score is 7. Higher scores indicate greater use of the emotion regulation strategy.
• Change From Baseline in Adolescents' Emotional Self-efficacy [Baseline and Week 4]: Adolescents will be asked to respond to 27 questions (e.g., I can tell when my feelings change; 1 = Not confident at all; 5 = Very confident) that assess their beliefs about their ability to understand and manage emotions. The measure has four factors: Using and managing your own emotions; Identifying and understanding your own emotions; Dealing with emotions in others; Perceiving emotion through facial expressions and body language. Responses will be averaged across the four factors and the minimum scale score is 1 and the maximum scale score is 5. Higher scores indicate greater emotional self-efficacy.
• Change From Baseline in Adolescents' General Anxiety [Baseline and Week 4]: Adolescents will be asked to respond to 7 items that assess general anxiety (e.g., Over the last two weeks, how often have you been bothered by the following problems… feeling nervous, anxious, or on edge; 0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day). Responses will be summed across the 7 items and the minimum scale score is 0 and the maximum scale score is 21. Higher scores indicate greater general anxiety.
• Change From Baseline in Adolescents' Social Anxiety [Baseline and Week 4]: Adolescents will be asked to respond to 18 items (e.g., It's hard for me to ask others to do things with me; 1 = Not at all; 5 = All the time) that assess social anxiety. The measure has three factors: Fear of Negative Evaluation, Social Avoidance and Distress-New; Social Avoidance and Distress. Responses will be summed across each of the three factors. The minimum scale score is 1 and the maximum scale score is 40. Higher scores indicate greater social anxiety.
• Change From Baseline in Adolescents' Wellbeing [Baseline and Week 4]: Adolescents will be asked to respond to a total of 7 items that assess their overall health and wellbeing using the PROMIS Pediatric Scale - Global Health 7 measure. Adolescents will respond to 4 items (e.g., In general, would you say your quality of life is…; 5 = Excellent, 1 = Poor); 1 item (e.g., How often do you feel really sad; 5 = Never; 1 = Always); and 2 items (e.g., How often do you have fun with friends?; 5 = Always; 1 = Never). Responses were summed across the 7 items to create a single global health score. The scoring table in the PROMIS Global Health Scoring manual was used to convert a summed global health score into a T score value for each participant. The T score has a mean of 50 with a standard deviation of 10. Higher T scores on this measure represent greater adolescent overall health and wellbeing.
• Change From Baseline in Parent Report of Adolescents' Emotion Regulation [Baseline and Week 4]: Parents will be asked to respond to 24 questions (e.g., Responds positively to neutral or friendly overtures by peers; 1= Never; 4 = Always) that assess parent ratings of their adolescents' emotion regulatory abilities. There are two subscales for this measure: Emotion Regulation and Negativity. Responses will be averaged across the two subscales and the minimum scale score is 1 and the maximum scale score is 4. Higher scores indicate greater use of the emotion regulation strategy.
• Change From Baseline in Parent Report of Adolescents' Executive Functioning [Baseline and Week 4]: Parents will be asked to respond to 24 questions (e.g., Has difficulty thinking ahead or learning from experience; 1 = Definitely not true; 5 = Definitely true) that assess parent ratings of their adolescents' executive functioning. There are four subscales: Working Memory, Planning, Inhibition, and Regulation. Responses will be averaged across the four subscales and the minimum scale score is 1 and the maximum scale score is 5. Higher scores indicate greater executive functioning deficit.
• Change From Baseline in Parent Report of Adolescents' Anxiety [Baseline and Week 4]: Parents will be asked to respond to 8 questions (e.g., My child worries about things; 0 = Never; 3 = Always) that assess parent ratings of their adolescents' anxiety. Responses will be summed across the 8 items and the minimum scale score is 0 and the maximum scale score is 24. Higher scores indicate greater anxiety.
• Change From Baseline in Parent Report of Adolescents' Wellbeing [Baseline and Week 4]: Parents will be asked to respond to a total of 7 items that assess parent ratings of their adolescents' overall health and wellbeing using the PROMIS Parent Proxy Scale - Global Health 7. Parents will respond to 4 items (e.g., In general, would you say your child's quality of life is…; 5 = Excellent, 1 = Poor); 1 item (e.g., How often does your child feel really sad; 5 = Never; 1 = Always); and 2 items (e.g., How often does your child have fun with friends?; 5 = Always; 1 = Never). Responses were summed across the 7 items to create a single global health score. The scoring table in the PROMIS Global Health Scoring manual was used to convert a summed global health score into a T score value for each participant. The T score has a mean of 50 with a standard deviation of 10. Higher T scores on this measure represent greater adolescent overall health wellbeing as rated by their parent.

Sex: All, ages: 12 Years to 19 Years, accepts healthy volunteers

Inclusion Criteria:

To be included in the study, youth must:

* Have received a diagnosis of 22Q11.DS (also known as VeloCardioFacial Syndrome or DiGeorge syndrome)
* Be between the ages of 12 and 19 years old
* Have an IQ of greater than or equal to 55
* Have regular internet and computer access
* Speak and read English (all study and program materials are in English)

To be included in the study, parents must:

* Have a participating youth in the study
* Read fluently in English (all study and program materials are in English)

Exclusion Criteria:

\- Only one parent per youth may participate

Participant flow

Outcome results

• Change From Baseline in Adolescents' Coping Skills (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 3.10 +/- .15; Wait-List Control 2.68 +/- .13 (p 0.04)
• Change From Baseline in Adolescents' Emotion Regulation (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 4.49 +/- .21; Wait-List Control 4.21 +/- .18 (p 0.32)
• Change From Baseline in Adolescents' Emotional Self-efficacy (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 3.33 +/- .10; Wait-List Control 3.24 +/- .09 (p 0.53)
• Change From Baseline in Adolescents' General Anxiety (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 5.90 +/- 1.07; Wait-List Control 8.08 +/- .92 (p 0.16)
• Change From Baseline in Adolescents' Social Anxiety (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 23.06 +/- 1.49; Wait-List Control 22.14 +/- 1.32 (p 0.65)
• Change From Baseline in Adolescents' Wellbeing (Primary), Least squares mean, T score: Online Mindfulness Intervention 45.60 +/- 1.86; Wait-List Control 47.11 +/- 1.62 (p 0.55)
• Change From Baseline in Parent Report of Adolescents' Emotion Regulation (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 2.05 +/- .05; Wait-List Control 2.17 +/- .05 (p 0.11)
• Change From Baseline in Parent Report of Adolescents' Executive Functioning (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 3.54 +/- .10; Wait-List Control 3.73 +/- .08 (p 0.14)
• Change From Baseline in Parent Report of Adolescents' Anxiety (Primary), Least squares mean, units on a scale: Online Mindfulness Intervention 8.59 +/- .48; Wait-List Control 8.10 +/- .42 (p 0.45)
• Change From Baseline in Parent Report of Adolescents' Wellbeing (Primary), Least squares mean, T score: Online Mindfulness Intervention 37.88 +/- .82; Wait-List Control 37.71 +/- .73 (p 0.88)

Adverse events

Time frame: 6 weeks

• Study Protocol and Statistical Analysis Plan (PDF, 2023-03-06)

• Alison Parker, PhD, Principal investigator, Innovation Research & Training