Background: Frequent exposure to criticism is a known risk factor for various adult psychiatric disorders. Adolescents may be even more vulnerable to (parental) criticism, as their imbalanced brain maturation makes them prone to stronger mood changes and less effective emotional regulation. Identifying which adolescent subgroups are more vulnerable than others could be of great clinical relevance. Perceived criticism (PC) and self-criticism (SC), two related but distinct traits, could well be crucial vulnerability factors.Hypotheses: After exposure to criticism during fMRI scanning, rapid changes in amygdalar functional connectivity (FC) with other brain areas involved in emotion regulation and social cognitive processing will occur. These changes will depend on trait moderators, such as the adolescents' proneness to (a) perceive others as critical of them (PC) or (b) perceive themselves positively or negatively (SC).Methods: Sixty-four healthy 14–17-year-olds were exposed to a series of auditory comments. Changes in mood states were assessed based on the Profile of Mood States (POMS) prior to and after exposure to these segments. Pre- and post-experiment FC of the left and right amygdalae with other brain areas were also measured. Correlates between FC changes and psychometric measures—including the perceived criticism measure (PCM) and self-perception profile for adolescents (SPPA)—were assessed.Results: First, after being criticized, FC increases of the left amygdala seed region with brain areas related to sustained emotional processing were found, but no right amygdalar FC changes. Second, there was a significant positive partial correlation between individual PCM scores and FC changes between the left amygdala seed region and the left precuneus and left superior parietal cortex, both part of the default mode network.Conclusion: Exposure to criticism resulted in a rapid negative mood change accompanied by an increase in FC between the left amygdala and regions known to be involved in sustained emotional processing, but no right amygdalar FC changes. Furthermore, higher PC but not SC was correlated with stronger left amygdalar FC increases with these regions, suggesting an elevated vulnerability for disturbed emotional processing, as observed in mood disorders, in healthy adolescents with higher PCM scores.

Background: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. Objectives: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. Methods: Parents of 27 children aged 7–17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. Results: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. Conclusion: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.

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