{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:18:34Z","timestamp":1778635114540,"version":"3.51.4"},"reference-count":46,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 108\\u20132314-B-227-007"],"award-info":[{"award-number":["MOST 108\\u20132314-B-227-007"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["2314-B-227-007"],"award-info":[{"award-number":["2314-B-227-007"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","pediatricnursing.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pediatric Nursing"],"published-print":{"date-parts":[[2022,1]]},"DOI":"10.1016\/j.pedn.2021.07.013","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T01:06:44Z","timestamp":1627434404000},"page":"e84-e90","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":13,"special_numbering":"C","title":["Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome"],"prefix":"10.1016","volume":"62","author":[{"given":"Mei-Yin","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huei-Shyong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu-Ying","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.pedn.2021.07.013_bb0005","series-title":"Diagnostic and statistical manual of mental disorders (DSM-5)","author":"American Psychiatric Association","year":"2013"},{"issue":"6","key":"10.1016\/j.pedn.2021.07.013_bb0010","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator\u2013mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"Journal of Personality and Social Psychology"},{"issue":"5","key":"10.1016\/j.pedn.2021.07.013_bb0015","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/1469-7610.00366","article-title":"Peer relationship problems in children with Tourette\u2019s disorder or diabetes mellitus","volume":"39","author":"Bawden","year":"1998","journal-title":"Journal of Child Psychology and Psychiatry"},{"key":"10.1016\/j.pedn.2021.07.013_bb0020","series-title":"The ecology of human development: Experiments by nature and design","author":"Bronfenbrenner","year":"1979"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0025","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1177\/0145445514522056","article-title":"The modulating role of stress in the onset and course of Tourette\u2019s syndrome: A review","volume":"38","author":"Buse","year":"2014","journal-title":"Behavior Modification"},{"issue":"3\u20134","key":"10.1016\/j.pedn.2021.07.013_bb0030","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/j.1365-2702.2009.03061.x","article-title":"Establishment of the reliability and validity of the stress index for children or adolescents with Tourette syndrome (SICATS)","volume":"19","author":"Chao","year":"2010","journal-title":"Journal of Clinical Nursing"},{"key":"10.1016\/j.pedn.2021.07.013_bb0035","doi-asserted-by":"crossref","first-page":"75","DOI":"10.2147\/AHMT.S175765","article-title":"Social stigma and self-perception in adolescents with tourette syndrome","volume":"10","author":"Cox","year":"2019","journal-title":"Adolescent Health, Medicine and Therapeutics"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0040","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13034-017-0196-x","article-title":"Tourette syndrome and other neurodevelopmental disorders: A comprehensive review","volume":"11","author":"Cravedi","year":"2017","journal-title":"Child and Adolescent Psychiatry and Mental Health"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0045","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1037\/0033-2909.115.1.74","article-title":"A review and reformulation of social information-processing mechanisms in children\u2019s social adjustment","volume":"115","author":"Crick","year":"1994","journal-title":"Psychological Bulletin"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0050","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1365-2214.2009.00983.x","article-title":"The quality of life of young people with Tourette syndrome","volume":"35","author":"Cutler","year":"2009","journal-title":"Child: Care, Health and Development"},{"key":"10.1016\/j.pedn.2021.07.013_bb0055","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyt.2016.00097","article-title":"Comorbidities, social impact, and quality of life in Tourette syndrome","volume":"7","author":"Eapen","year":"2016","journal-title":"Frontiers in Psychiatry"},{"issue":"10","key":"10.1016\/j.pedn.2021.07.013_bb0060","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1111\/jpc.14165","article-title":"Tics and Tourette syndrome","volume":"54","author":"Efron","year":"2018","journal-title":"Journal of Paediatrics and Child Health"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0065","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"Journal of Clinical Epidemiology"},{"issue":"3","key":"10.1016\/j.pedn.2021.07.013_bb0070","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1353\/csd.2007.0024","article-title":"Social support, self-esteem, and stress as predictors of adjustment to university among first-year undergraduates","volume":"48","author":"Friedlander","year":"2007","journal-title":"Journal of College Student Development"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0075","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s12888-019-2219-z","article-title":"The mediating role of resilience and self-esteem between negative life events and positive social adjustment among left-behind adolescents in China: A cross-sectional study","volume":"19","author":"Gao","year":"2019","journal-title":"BMC Psychiatry"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0080","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1177\/0883073819877335","article-title":"Clinical features of Tourette syndrome","volume":"35","author":"Gill","year":"2020","journal-title":"Journal of Child Neurology"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0085","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s10578-015-0544-0","article-title":"Clinical correlates and mediators of self-concept in youth with chronic tic disorders","volume":"47","author":"Hanks","year":"2016","journal-title":"Child Psychiatry & Human Development"},{"key":"10.1016\/j.pedn.2021.07.013_bb0090","series-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach","author":"Hayes","year":"2013"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0095","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1001\/jamapsychiatry.2014.2650","article-title":"Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome","volume":"72","author":"Hirschtritt","year":"2015","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0100","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.jocrd.2014.03.004","article-title":"Clinical features of Tourette syndrome and tic disorders","volume":"3","author":"Leckman","year":"2014","journal-title":"Journal of obsessive-compulsive and related disorders"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0105","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/00004583-198907000-00015","article-title":"The Yale global tic severity scale: Initial testing of a clinician-rated scale of tic severity","volume":"28","author":"Leckman","year":"1989","journal-title":"Journal of the American Academy of Child & Adolescent Psychiatry"},{"issue":"3\u20134","key":"10.1016\/j.pedn.2021.07.013_bb0110","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/jocn.13074","article-title":"\u201cLiving with tics\u201d: Self-experience of adolescents with Tourette syndrome during peer interaction","volume":"25","author":"Lee","year":"2016","journal-title":"Journal of Clinical Nursing"},{"key":"10.1016\/j.pedn.2021.07.013_bb0115","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1016\/j.pedn.2019.05.023","article-title":"Development and validation of the social adjustment scale for adolescents with Tourette syndrome in Taiwan","volume":"51","author":"Lee","year":"2020","journal-title":"Journal of Pediatric Nursing"},{"issue":"1\u20132","key":"10.1016\/j.pedn.2021.07.013_bb0120","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/jocn.14564","article-title":"Social adjustment experiences of adolescents with Tourette syndrome","volume":"28","author":"Lee","year":"2019","journal-title":"Journal of Clinical Nursing"},{"key":"10.1016\/j.pedn.2021.07.013_bb0125","series-title":"Volume 1: Individual bases of adolescent development","article-title":"Handbook of adolescent psychology","author":"Lerner","year":"2009"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0130","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1469-7610.2006.01687.x","article-title":"Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and\/or obsessive-compulsive disorder","volume":"48","author":"Lin","year":"2007","journal-title":"Journal of Child Psychology and Psychiatry"},{"issue":"3","key":"10.1016\/j.pedn.2021.07.013_bb0135","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.ridd.2012.01.001","article-title":"Youths with ADHD with and without tic disorders: Comorbid psychopathology, executive function and social adjustment","volume":"33","author":"Lin","year":"2012","journal-title":"Research in Developmental Disabilities"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0140","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s10882-016-9524-y","article-title":"\u201cI\u2019m not being rude, I\u2019d want somebody normal\u201d: Adolescents\u2019 perception of their peers with Tourette\u2019s syndrome: An exploratory study","volume":"29","author":"Malli","year":"2017","journal-title":"Journal of Developmental and Physical Disabilities"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0145","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/camh.12000","article-title":"Does it help to talk about tics? An evaluation of a classroom presentation about Tourette syndrome","volume":"19","author":"Nussey","year":"2014","journal-title":"Child and Adolescent Mental Health"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0150","doi-asserted-by":"crossref","first-page":"2","DOI":"10.5172\/mra.2013.7.1.2","article-title":"Foreword: Using Bronfenbrenner\u2019s ecological systems theory to frame quantitative, qualitative, and mixed research","volume":"7","author":"Onwuegbuzie","year":"2013","journal-title":"International journal of multiple research approaches"},{"issue":"5","key":"10.1016\/j.pedn.2021.07.013_bb0155","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1177\/0963721414547414","article-title":"The development of self-esteem","volume":"23","author":"Orth","year":"2014","journal-title":"Current Directions in Psychological Science"},{"issue":"19","key":"10.1016\/j.pedn.2021.07.013_bb0160","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1212\/WNL.0000000000007466","article-title":"Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"Pringsheim","year":"2019","journal-title":"Neurology"},{"key":"10.1016\/j.pedn.2021.07.013_bb0165","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyg.2016.01749","article-title":"The mediating role of psychological adjustment between peer victimization and social adjustment in adolescence","volume":"7","author":"Romera","year":"2016","journal-title":"Frontiers in Psychology"},{"key":"10.1016\/j.pedn.2021.07.013_bb0170","series-title":"Society and the adolescent self-image","author":"Rosenberg","year":"1965"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0175","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/mds.26089","article-title":"Population prevalence of Tourette syndrome: A systematic review and meta-analysis","volume":"30","author":"Scharf","year":"2015","journal-title":"Movement Disorders"},{"issue":"5","key":"10.1016\/j.pedn.2021.07.013_bb0180","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.ejpn.2018.05.008","article-title":"Self-concept and self-esteem in patients with chronic tic disorders: A systematic literature review","volume":"22","author":"Silvestri","year":"2018","journal-title":"European Journal of Paediatric Neurology"},{"issue":"8","key":"10.1016\/j.pedn.2021.07.013_bb0185","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1177\/1359105314566647","article-title":"Investigating young people\u2019s experiences of successful or helpful psychological interventions for tic disorders: An interpretative phenomenological analysis study","volume":"21","author":"Smith","year":"2016","journal-title":"Journal of Health Psychology"},{"issue":"6","key":"10.1016\/j.pedn.2021.07.013_bb0190","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1542\/peds.87.6.936","article-title":"Peer problems in Tourette\u2019s disorder","volume":"87","author":"Stokes","year":"1991","journal-title":"Pediatrics"},{"issue":"4","key":"10.1016\/j.pedn.2021.07.013_bb0195","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1037\/1040-3590.17.4.486","article-title":"Reliability and validity of the Yale global tic severity scale","volume":"17","author":"Storch","year":"2005","journal-title":"Psychological Assessment"},{"issue":"1","key":"10.1016\/j.pedn.2021.07.013_bb0200","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12888-016-0717-9","article-title":"Difficulties experienced by young people with Tourette syndrome in secondary school: A mixed methods description of self, parent and staff perspectives","volume":"16","author":"Wadman","year":"2016","journal-title":"BMC Psychiatry"},{"issue":"6","key":"10.1016\/j.pedn.2021.07.013_bb0205","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/cch.12033","article-title":"\u201cEverybody just thinks I\u201dm weird\u2019: A qualitative exploration of the psychosocial experiences of adolescents with Tourette syndrome","volume":"39","author":"Wadman","year":"2013","journal-title":"Child: Care, Health and Development"},{"key":"10.1016\/j.pedn.2021.07.013_bb0210","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/S0387-7604(03)90005-2","article-title":"Tourette\u2019s syndrome in Taiwan: An epidemiological study of tic disorders in an elementary school at Taipei County","volume":"25","author":"Wang","year":"2003","journal-title":"Brain and Development"},{"issue":"2","key":"10.1016\/j.pedn.2021.07.013_bb0215","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1365-2648.2009.05159.x","article-title":"Risk behaviours among early adolescents: Risk and protective factors","volume":"66","author":"Wang","year":"2010","journal-title":"Journal of Advanced Nursing"},{"issue":"3","key":"10.1016\/j.pedn.2021.07.013_bb0220","doi-asserted-by":"crossref","first-page":"791","DOI":"10.2466\/04.07.10.PR0.108.3.791-798","article-title":"Social adjustment, academic performance, and creativity of Taiwanese children with Tourette\u2019s syndrome","volume":"108","author":"Wei","year":"2011","journal-title":"Psychological Reports"},{"key":"10.1016\/j.pedn.2021.07.013_bb0225","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.comppsych.2018.04.008","article-title":"Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity","volume":"84","author":"Weingarden","year":"2018","journal-title":"Comprehensive Psychiatry"},{"issue":"30","key":"10.1016\/j.pedn.2021.07.013_bb0230","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000004354","article-title":"The prevalence of tic disorders for children in China: A systematic review and meta-analysis","volume":"95","author":"Yang","year":"2016","journal-title":"Medicine"}],"container-title":["Journal of Pediatric Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0882596321002177?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0882596321002177?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T18:56:04Z","timestamp":1777575364000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0882596321002177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":46,"alternative-id":["S0882596321002177"],"URL":"https:\/\/doi.org\/10.1016\/j.pedn.2021.07.013","relation":{},"ISSN":["0882-5963"],"issn-type":[{"value":"0882-5963","type":"print"}],"subject":[],"published":{"date-parts":[[2022,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome","name":"articletitle","label":"Article Title"},{"value":"Journal of Pediatric Nursing","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pedn.2021.07.013","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}