Mental health services utilization by maltreated children: research findings and recommendations

Many maltreated children have, or are at risk for, emotional and behavioral disorders. Some of these children need mental health services but do not receive them because of service delivery and use barriers. Knowledge about the factors related to service utilization is needed to increase access to and use of services. Studies on mental health services utilization by maltreated children in foster care or otherwise monitored by child protective services are reviewed to ascertain service use correlates. Children in foster care had higher use rates than comparison groups of Aid to Families With Dependent Children not in foster care. Need and nonneed variables predicted service use. Race was the most consistent nonneed predictor. Future research needs include the development of conceptual models to guide research on service access and use. More work is needed on the conceptualization and operationalization of mental health services, need for services, and service use.

Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors

PURPOSE

To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents.

METHODS

Data were derived from 692 adolescents in 9th and 10th grades (x = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a self-administered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana).

RESULTS

For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males.

CONCLUSIONS

Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.

A transactional model of oppositional behavior: underpinnings of the Collaborative Problem Solving approach

Oppositional defiant disorder (ODD) refers to a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures. ODD is one of the most common (and debilitating) comorbid disorders within Tourette's disorder (TD). Diverse psychosocial treatment approaches have been applied to children's ODD-related behaviors. In this paper, the authors articulate a transactional developmental conceptualization of oppositional behavior and describe a cognitive-behavioral model of intervention-called collaborative problem solving (CPS)-emanating from this conceptualization. The specific goals of the CPS approach are to help adults (1). understand the specific adult and child characteristics contributing to the development of a child's oppositional behavior; (2). become cognizant of three basic strategies for handling unmet expectations, including (a). imposition of adult will, (b). CPS, and (c). removing the expectation; (3). recognize the impact of each of these three approaches on parent-child interactions; and (4). become proficient, along with their children, at CPS as a means of resolving disagreements and defusing potentially conflictual situations so as to reduce oppositional episodes and improve parent-child compatibility. Summary data from an initial study documenting the effectiveness of the CPS approach (in comparison to the standard of care) are also presented.

Assessing the wraparound process during family planning meetings

Research and evaluation of the wraparound process has typically focused on outcomes, service providers, and costs. While many of these studies describe a process that is consistent with the wraparound approach, few studies have reported attempts to monitor or measure the treatment fidelity of the wraparound process. The purpose of this study was to assess the fidelity of the wraparound process in a community-based system of care using the Wraparound Observation Form-Second Version. Results from 112 family planning meetings indicated some strengths and weaknesses within the current system. Families and professionals were frequently involved in the planning and implementation of the wraparound process. However, informal supports and natural family supports were not present in a majority of the meetings. Given the significant number of youth served in wraparound programs, the benefits of using the Wraparound Observation Form-Second Version as an instrument to monitor the fidelity of the wraparound approach should not be ignored.

A biopsychosocial model of the development of chronic conduct problems in adolescence

A biopsychosocial model of the development of adolescent chronic conduct problems is presented and supported through a review of empirical findings. This model posits that biological dispositions and sociocultural contexts place certain children at risk in early life but that life experiences with parents, peers. and social institutions increment and mediate this risk. A transactional developmental model is best equipped to describe the emergence of chronic antisocial behavior across time. Reciprocal influences among dispositions, contexts, and life experiences lead to recursive iterations across time that exacerbate or diminish antisocial development. Cognitive and emotional processes within the child, including the acquisition of knowledge and social-information-processing patterns, mediate the relation between life experiences and conduct problem outcomes. Implications for prevention research and public policy are noted.

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.

Family-strengthening approaches for the prevention of youth problem behaviors

Effective parenting is the most powerful way to reduce adolescent problem behaviors. Dissemination of research-based family interventions has been slow, with most practitioners still implementing ineffective programs. This article reviews 2 federal studies that involved national searches for effective family interventions targeting pre-birth to adolescence: Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches (Center for Substance Abuse Prevention, 1998) and Strengthening America's Families (R. Alvarado, K. L. Kumpfer, K. Kendall, S. Beesley, & C. Lee-Cavaness, 2000). Results identified 3 effective prevention approaches, 13 principles of effectiveness, and 35 programs. Recommendations include increased dissemination research on training and technical assistance systems, adoption with fidelity and quality, and gender-, age-, and culturally sensitive adaptations.

Co-occurrence between marital aggression and parents' child abuse potential: the impact of cumulative stress

Evidence suggests that marital aggression and parent-to-child aggression sometimes occur within the same family, but little is known about why certain families are vulnerable to multiple forms of family aggression. According to family systems theory, negative affect in one family relationship can spread to other family relationships. According to family stress theory, aversive circumstances increase families' vulnerability to disruption and conflict. Based on these theories, the present study tests the hypothesis that cumulative family stresses potentiate the association between marital aggression and parents' child abuse potential. In a series of additive interactional models, husband-to-wife aggression was linked to husbands' and wives' child abuse potential in a context of both high financial stress and high parenting stress but was not linked in a context of low stress. Wife-to-husband aggression was linked to wives', but not husbands', child abuse potential in a context of high stress. These results highlight the potential role of contextual factors in the pervasiveness of aggressive exchanges across multiple family subsystems.

Child-related cognitions and affective functioning of physically abusive and comparison parents

OBJECTIVE

The goal of this research was to utilize the cognitive behavioral model of abusive parenting to select and examine risk factors to illuminate the unique and combined influences of social cognitive and affective variables in predicting abuse group membership.

METHODOLOGY

Participants included physically abusive parents (n=56) and a closely-matched group of comparison parents (n=62). Social cognitive risk variables measured were (a) parent's expectations for children's abilities and maturity, (b) parental attributions of intentionality of child misbehavior, and (c) parents' perceptions of their children's adjustment. Affective risk variables included (a) psychopathology and (b) parenting stress. A series of logistic regression models were constructed to test the individual, combined, and interactive effects of risk variables on abuse group membership.

RESULTS

The full set of five risk variables was predictive of abuse status; however, not all variables were predictive when considered individually and interactions did not contribute significantly to prediction. A risk composite score computed for each parent based on the five risk variables significantly predicted abuse status. Wide individual differences in risk across the five variables were apparent within the sample of abusive parents.

CONCLUSIONS

Findings were generally consistent with a cognitive behavioral model of abuse, with cognitive variables being more salient in predicting abuse status than affective factors. Results point to the importance of considering diversity in characteristics of abusive parents.

Evaluating the parental fitness of psychiatrically diagnosed individuals: advocating a functional-contextual analysis of parenting

The parental fitness of psychiatrically diagnosed individuals is often questioned in termination of parental rights cases. The goal of this article is to shift the focus from a predisposing bias of unfitness to a functional-contextual analysis of parenting behavior and competency. Three underlying biased assumptions are relevant for the courts' decision making: (a) that a diagnosis (past or present) predicts inadequate parenting and child risk, (b) that a diagnosis predicts unamenability to parenting interventions, and (c) that a diagnosis means the parent is forever unfit. Each assumption will be considered in light of empirical evidence, with major depression, schizophrenia, substance abuse, and mental retardation provided as examples of diagnostic labels often assumed to render a parent unfit. A research agenda to improve clinicians' ability to assess parental fitness and understanding of how parental mental illness, mental retardation, or substance abuse might compromise parenting capacities is discussed for forensic purposes.

Family psychoeducation: an adjunctive intervention for children with bipolar disorder

Childhood onset bipolar disorder is associated with significant morbidity and mortality, yet effective treatment strategies have remained underdeveloped and understudied. While some headway is being made vis-a-vis pharmacologic treatments, empirical efforts have not focused on adjunctive psychosocial interventions for childhood bipolar disorder. In this review, we discuss psychoeducation, delivered via workshops, multifamily psychoeducation groups, or individual-family psychoeducation, as an adjunct to the ongoing pharmacotherapy, psychotherapy, and school-based interventions for children with bipolar disorder. We review the theoretical rationale for psychoeducation, including expressed emotion and caregiver concordance; summarize findings in the adult literature; and then describe our development and testing of psychoeducational interventions for mood-impaired children. Data from three pilot studies are reviewed, and progress on two studies currently underway is presented. We conclude with current limitations of psychoeducation and recommendations for future study to develop psychoeducation as an empirically supported adjunctive intervention for children with bipolar disorder.

Preventive intervention for urban, low-income preschoolers at familial risk for conduct problems: a randomized pilot study

Conducted a pilot study to test the feasibility of a prevention program for promoting parenting in families of preschoolers at high risk for behavior problems. Risk status was based on a family history of antisocial behavior and residence in a low-income, urban community. Thirty preschoolers (ages 21/2 to 5) and their parents were randomly assigned to a 1-year, home- and clinic-based intervention or to a no-intervention control condition. Despite families' multiple risk factors, high rates of attendance and satisfaction were achieved. Relative to controls, intervention parents were observed to be significantly more responsive and use more positive parenting practices. Results support the feasibility of engaging high-risk families in an intensive prevention program. The meaningful changes achieved in parenting suggest that a preventive approach is promising for families with multiple risk factors.

Punishment insensitivity and parenting: temperament and learning as interacting risks for antisocial behavior

We review ideas about individual differences in sensitivity or responsiveness to common disciplinary behaviors parents use to correct aggressive and antisocial behavior in children. At extremes, children may be seen as "punishment-insensitive," an heuristic with some value relevant to models of the development of antisocial and aggressive behavior disorders. Literature from diverse fields, such as psychopathy, child temperament, socialization and the development of moral conscience, conditioning theory, and personality theory, have all utilized the idea that humans differ in their sensitivity to aversive stimuli and the cues that signal their occurrence, as well as their ability to inhibit reward-driven behavior, in the presence of punishment cues. Contemporary thinking places these dispositions squarely as basic biological aspects of temperament that moderate the effects of the environment (e.g., parenting) on outcomes (e.g., mental health). We review a largely forgotten literature that shows clearly that sensitivity to punishment is also reliably influenced by the environment itself. An attempt is then made to model the interactional processes by which parenting and punishment sensitivities in children magnify or diminish each other's progress toward healthy or antisocial development. Implications for parenting of children with low responsiveness to punishment strategies are discussed.

Relations of positive and negative affectivity to anxiety and depression in children: evidence from a latent variable longitudinal study

The tripartite model of anxiety and depression has been studied with adults; however, support is still emerging with children concerning measurement and relations between positive (PA) and negative (NA) affect and psychopathology. In this longitudinal study of 270 4th- to 11th-grade children (mean age = 12.9 years, SD = 2.23). confirmatory factor analysis supported a 2-factor orthogonal model of children's self-reported affect and revealed that the concurrent relations of NA and PA to anxiety and depression symptoms were consistent with the tripartite model. Structural equation modeling demonstrated moderate cross-time stability of trait PA and NA, consistent with a temperament view of these factors, as well as partial support for the role of NA and PA in the development of anxiety and depression symptoms in children.

Diagnostic threshold for conduct disorder in girls and boys

Concerns about gender bias in the diagnostic criteria for conduct disorder (CD) have prompted some researchers to recommend that the diagnostic threshold in girls be lowered. Since CD is a highly familial condition, the authors assessed the diagnostic validity of subthreshold CD in girls using family study methodology. They compared the rates of antisocial disorders (CD and antisocial personality disorder) in relatives of four groups of index children: children with attention deficit hyperactivity disorder (ADHD) and full, subthreshold, or no CD diagnoses and non-ADHD/non-CD control subjects. Results showed no interaction between gender and familiality across the four groups. Furthermore, there was no significant evidence of familiality of subthreshold CD. From a family genetic perspective, the diagnostic threshold for CD does not appear to differ by gender. The current results support the possibility that differential rates of CD reflect actual differences in rates of antisocial behavior across gender.

Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.

Emotional responses to antisocial acts in adolescent males with conduct disorder: a link to affective morality

Examined the role of emotion-based moral processes in the committing of delinquent acts by adolescent males with conduct disorder (CD). An Affective Morality Index (AMI) was developed to assess emotional responses to vignettes of delinquent acts. CD groups, as compared to a non-CD group, reported lower levels of guilt and fear and higher levels of excitement and happiness following described transgressions. Number of CD symptoms and a recidivism-risk item were correlated negatively with reported guilt and fear and positively with happiness and excitement. Trends suggested that youth with childhood-onset CD (CO) show lower levels of affective morality than those with adolescent-onset CD (AO). There were no effects for anger. This research, and in particular the AMI, expands our understanding of affective-based morality, especially in discriminating between CD and non-CD youth.

One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis

OBJECTIVE

This study presents findings from a 1-year follow-up to a randomized clinical trial comparing multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, with inpatient psychiatric hospitalization.

METHOD

One hundred fifty-six children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization followed by usual services. Assessments examining mental health symptoms, out-of-home placement, school attendance, and family relations were conducted at five times: within 24 hours of recruitment, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), at the completion of MST (average of 4 months postrecruitment), and 10 and 16 months postrecruitment.

RESULTS

Based on placement and youth-report measures, MST was initially more effective than emergency hospitalization and usual services at decreasing youths' symptoms and out-of-home placements and increasing school attendance and family structure, but these differences generally dissipated by 12 to 16 months postrecruitment. Hospitalization produced a rapid, but short-lived, decrease in externalizing symptoms based on caregiver reports.

CONCLUSION

Findings suggest that youths with serious emotional disturbance might benefit from continuous access to a continuum of evidence-based practices titrated to clinical need.

Treatment of alcohol use disorders in adolescents

The treatment of alcohol use disorders (AUDs) in adolescents is a very important issue in the field of substance use disorders; however, it is a complex and understudied area in which there are limited data concerning evidence-based treatment. The authors first briefly review the epidemiology of AUDs in adolescents, describe existing guidelines for the treatment of such disorders in adolescent patients, and consider differences between AUDs as they present in adolescents and adults. In the next section of the paper, the authors review the assessment and diagnosis of AUDs in adolescents and consider how findings from such assessments will influence subsequent treatment planning. They also describe prognostic factors (e.g., family issues, socioeconomic factors, psychiatric comorbidity, gender, ability to form a therapeutic alliance) that may affect treatment outcome and need to be considered in treatment selection. The various settings in which adolescent AUDs may be treated and the types of patients and situations for which each is most appropriate are described. The second half of the article focuses on the treatment of adolescents with AUDs. The authors describe techniques for establishing abstinence and then preventing subsequent relapse. Although there is an interest in the use of medications (e.g., naltrexone) to treat AUDs in this population, there are unfortunately few if any data concerning the use of these agents in adolescent patients. More data are available concerning psychosocial treatments. The authors describe a variety of psychosocial modalities that have been tested in adolescents, including individual psychotherapy (e.g., interpersonal therapy, cognitive-behavioral therapy, motivational enhancement therapy), group therapies, 12 step/self-help programs, family therapy, skills training for parents, and psychoeducation. The authors then consider the importance of targeting comorbid psychiatric conditions, especially anxiety and depression, in the treatment of AUDs in adolescents. The authors stress the importance of being aware that adolescents with AUDs are at increased risk for violence against self or others and suicide. They also note that practitioners who work with adolescents with AUDs often need to deal with forensic issues (e.g., DUI charges).

A multilevel study of neighborhoods and parent-to-child physical aggression: results from the project on human development in Chicago neighborhoods

The majority of children in the United States experience parent-to-child physical aggression (PCPA), a disciplinary strategy out of favor with many experts. Several decades of research have documented a link between community characteristics and severe child maltreatment. None have taken a multilevel approach to study whether neighborhoods affect the amount of corporal punishment and/or physical abuse used by individual families. Data for this article come from the Project on Human Development in Chicago Neighborhoods and were analyzed using hierarchical linear modeling. An interval scale of PCPA was developed. Values obtained show that several neighborhood characteristics were associated with PCPA. Immigrant concentration remained significant after controlling for family composition. A cross-level interaction was found between neighborhood social networks and Hispanic race/ethnicity. The article's conclusion is that neighborhood characteristics may influence the amount of PCPA used by families. Neighborhood intervention strategies hold promise.

Theory, measurement, and methods in the study of family influences on adolescent smoking

This paper discusses three dilemmas faced by researchers interested in family influences in substance use: the transitional nature of adolescent smoking, the complexity and multi-dimensionality of family forms and influences, and the inter-relationship of family influences with other key developmental contexts. Methodological and conceptual issues stemming from these dilemmas are discussed with regard to understanding why previous reviews have found the correlations between family predictors and adolescent smoking to be relatively low. In particular, the importance of understanding time, the transitional nature of the phenomenon, and within- and between- family processes are emphasized. More appropriate conceptual and statistical models for analyzing family influences are suggested, including both mixed models and person-centered approaches.

Longitudinal direct and indirect pathways linking older sibling competence to the development of younger sibling competence

A 4-wave longitudinal model tested direct and indirect links between older sibling (OS; M = 11.7 years) and younger sibling (YS; M = 9.2 years) competence in 152 rural African American families. Data were collected at 1-year intervals. At each wave, different teachers assessed OS competence, YS competence, and YS self-regulation. Mothers reported their own psychological functioning; mothers and YSs reported parenting practices toward the YS. OS competence was stable across time and was linked with positive changes in mothers' psychological functioning from Wave 1 to Wave 2. Mothers' Wave 2 psychological functioning was associated with involved-supportive parenting of the YS at Wave 3. OS Wave 2 competence and Wave 3 parenting were indirectly linked with Wave 4 YS competence, through Wave 3 YS self-regulation. Structural equation modeling controlled for Wave 1 YS competence; thus, the model accounted for change in YS competence across 3 years.

Tracing the roots of early sexual debut among adolescents in psychiatric care

OBJECTIVE

To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers.

METHOD

One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist.

RESULTS

Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at < or =14 or >14 years of age.

CONCLUSIONS

Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut.

Evaluation of an intervention system for parents of children with intellectual disability and challenging behaviour

BACKGROUND

Signposts is a flexible intervention system for families of children who have intellectual disability and challenging behaviour. The Signposts materials include eight information booklets, a workbook and videotape for parents, and a series of instructional manuals for therapists. The system was designed so that it can be delivered in several different ways, i.e. group support, telephone support and self-directed modes.

METHODS

The present study was an evaluation of these three modes of delivery and involved 115 families.

RESULTS

Following the use of the Signposts materials in parent training programmes, the subjects reported that they were less stressed, felt more efficacious about managing their children's behaviour, were less hassled about meeting their own needs and that their children's behaviour had improved. Additionally, families generally reported high levels of satisfaction with the content and delivery of the materials.

CONCLUSIONS

Finally, there were minimal differences among the three modes of delivery on the measures used, although families who used the self-directed mode were less likely to complete the materials. Implications of these results for service delivery are discussed.

Recognition and treatment of mental disorders in children: considerations for pediatric health systems

General healthcare systems currently play an active role in the identification and treatment of children with mental disorders. As many as one-third of children identified and treated for mental health problems receive outpatient mental healthcare from primary care providers. Although some children do receive treatment, over half of those who need mental health care do not receive this service. Fortunately, current levels of unmet need for adequate care coincide with mounting scientific evidence to support the efficacious use of psychosocial, community-based, and pharmacological interventions. Scientific evidence indicates that the appropriate identification and treatment of mental disorders in childhood can reduce symptoms of child psychopathology, improve adaptive functioning, and sometimes serve as a buffer to further long-term impairment. However, mental health treatment can only be beneficial if it reaches those families in need, is amenable to clinical practice implementation, and is administered with an adequate dose. Future challenges lie in creating practice-relevant efficacious interventions to improve the identification of child mental health needs and to improve access to high quality, appropriate mental healthcare. Primary care settings will play an important role in this activity. Although many barriers exist, pediatric health systems will continue to play an important role in the identification and treatment of mental disorders in children. The quality of current pediatric mental healthcare could be enhanced by increased opportunities for physician training, a restructuring of current training efforts, an increased focus on patient engagement strategies, equitable care incentives and reimbursement, as well as an integrated view of physical and mental health.

Maltreatment and trauma: tracking the connections in adolescence

Posttraumatic stress disorder is one of the most common and often prolonged consequences of childhood maltreatment. In this article the authors consider theories of trauma continuity, with emphasis on a relational path to maladjustment that links childhood maltreatment to elevated trauma symptomatology and intimate victimization in adolescent dating relationships.

Helpless attributions and depression in adolescents: the roles of anxiety, event valence, and demographics

The relationship between helpless attributions and depression is well established. This study evaluated whether anxiety, event valence (positive or negative) and demographic variables (gender, age, socioeconomic status or race) influence this relationship. Results showed: (1) adolescents with anxiety and depression who were from lower socioeconomic backgrounds made less helpless attributions for negative events than did adolescents from higher socioeconomic backgrounds, (2) male adolescents with anxiety-only had helpless attribution styles that were similar to male adolescents with depression, but the same was not true for female adolescents, and (3) African-American adolescents showed less helpless attributions for negative events than did Caucasian adolescents. Results replicate past research showing that a helpless attribution style is associated with depression in adolescence, but suggest that this pattern may be influenced by demographic factors. Results also suggest that helpless attributions may be related to both anxiety and depression in males.

Entwicklungsorientierte Prävention von aggressiv-dissozialem Verhalten und Substanzmissbrauch

Zusammenfassung. Empirische Befunde verdeutlichen, dass frühere (positive/negative) Erfahrungen spätere Erfahrungen im Entwicklungsverlauf beeinflussen. Aus diesem Grund setzen Präventionen von aggressiv-dissozialem Verhalten und Substanzmissbrauch oft bereits im frühen Kindesalter an. Am Beispiel aggressiv-dissozialen Verhaltens und von Substanzmissbrauch werden die theoretischen und empirischen Grundlagen für entwicklungsorientierte Präventionen im Kindesalter dargestellt. Es wird sowohl auf die Darstellung des Auftretens der Störungen im Entwicklungsverlauf, als auch auf wichtige Risikobedingungen beider Störungen eingegangen. Anschließend werden Entwicklungsmodelle diskutiert, die zentrale Risikobedingungen der Störungen im Entwicklungsverlauf berücksichtigen. Wesentliche Eigenschaft entwicklungsorientierter Prävention stellt - wie gezeigt wird - die Förderung risikomildernder Bedingungen und die Förderung der Bewältigung von Entwicklungsaufgaben dar. Abschließend werden ausgewählte Präventionsprogramme im Vorschul- und frühen Schulalter vorgestellt.

Affective disorders

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.

Parent training of toddlers in day care in low-income urban communities

The authors tested a 12-week parent training program with parents (n = 208) and teachers (n = 77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training.

Callous-unemotional traits and developmental pathways to severe conduct problems

One method for defining pathways through which children develop severe conduct problems is based on the presence or absence of callous-unemotional (CU) traits. This study investigated potential differences between nonreferred children (mean age = 12.36 years; SD = 1.73) with and without CU traits (n = 98). Children with conduct problems, irrespective of the presence of CU traits, tended to have significant problems in emotional and behavioral regulation. In contrast, CU traits, irespective of the presence of conduct problems, were associated with a lack of behavioral inhibition. Hostile attributional biases were associated with conduct problems but only in boys and in the absence of CU traits. These findings suggest that the processes underlying deficits in emotional and behavioral regulation in children with conduct problems may be different for children with CU traits.

Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample.

Marital relationship and individual psychological characteristics that predict physical punishment of children

The relationships among use of physical punishment of children, marital conflict, and individual adult hostility were examined longitudinally. Couples expecting their first child completed self-report scales of individual hostility and were observed in marital problem-solving situations for level of marital conflict during the prenatal period. The marital problem-solving situations were again assessed at 2 years and 5 years following the child's birth. At the later time points, discipline practices were assessed through interview. A climate of negativity, manifested through either high rates of individual hostility or marital conflict, predicted the use of more frequent and severe physical punishment of children at 2 and 5 years, even when parent educational level was controlled. Implications for policy and parent education are discussed.

The impact of late-afternoon stimulant dosing for children with ADHD on parent and parent-child domains

Examined the impact of late-afternoon stimulant dosing on parent and parent-child domains. Twenty-one children with attention deficit hyperactivity disorder (ADHD) participated in a double-blind, placebo-controlled medication assessment comparing varying doses of methylphenidate (MPH) and Adderall in the context of an intensive treatment program. Children received varying doses of stimulant medication, including active medication or placebo at 3:30 p.m. daily. Parent ratings of their mood, pleasantness of parent-child interactions, and perceived parenting effectiveness and successfulness were obtained each evening. Effective medication doses had a beneficial impact on parent-child domains (e.g., parent-child interactions) but did not significantly affect non-child-related parent variables (e.g., negative affect [NA]). Findings suggested that doses with beneficial effects lasting into the evening improved parent reports of the pleasantness of parent-child interactions but were insufficient to produce positive changes in parent functioning.

Trajectories leading to school-age conduct problems

The present study applied a semiparametric mixture model to a sample of 284 low-income boys to model developmental trajectories of overt conduct problems from ages 2 to 8. As in research on older children, 4 developmental trajectories were identified: a persistent problem trajectory, a high-level desister trajectory, a moderate-level desister trajectory, and a persistent low trajectory. Follow-up analyses indicated that initially high and low groups were differentiated in early childhood by high child fearlessness and elevated maternal depressive symptomatology. Persistent problem and high desister trajectories were differentiated by high child fearlessness and maternal rejecting parenting. The implications of the results for early intervention research are discussed, with an emphasis on the identification of at-risk parent-child dyads.

Social skills training in children with attention deficit hyperactivity disorder: a randomized-controlled clinical trial

Evaluated efficacy of social skills training (SST) on children with 2 subtypes of attention deficit hyperactivity disorder (ADHD). Participants were 120 children (30 girls, 90 boys), ages 8 to 12 with ADHD-Inattentive type (ADHD-I; n = 59) or Combined type (ADHD-C; n = 61). The children were randomly assigned within diagnosis subtype to the treatment condition (8 weeks of SST) or the no-intervention control condition. SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD, yet did not affect the other domains of social competence. Diagnostically heterogeneous groups led to greater improvements on parent-report of their child's cooperation and assertion abilities as well as children's report of their own empathy skills. Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up. Children with comorbid oppositional defiant disorder (ODD) did not benefit as much from the intervention. Children with ADHD-I improved in assertion skills more than children with ADHD-C, yet the 2 diagnostic entities did not differ in improvement levels across all other social skills.

Associations of the serotonin transporter promoter polymorphism with aggressivity, attention deficit, and conduct disorder in an adoptee population

Prior studies of the Iowa Adoption cohorts have demonstrated that the degree of adoptee aggressiveness and conduct disorder has a significant genetic component. Other studies have implicated the neurotransmitter serotonin or polymorphisms in the serotonin transporter gene (5HTT) as an important source of variability in "externalizing" behaviors such as aggressivity, conduct disorder, and attention deficit-hyperactivity disorders (ADHD). Following this lead, we genotyped a subgroup of adoptees (n = 87) at high risk for these kinds of disorders with respect to the serotonin-transporter-linked promoter region (5HTTLPR) polymorphism, and used ordinal logistic regression to conduct an association study. Primary analysis failed to detect a main effect between 5HTTLPR status and subscales of aggressivity, conduct disorder, or attention deficit. However, when biologic parent status and sex of proband were considered, certain interactions between 5HTTLPR and other genetic risk factors were evident. One type of interaction with the LL variant of 5HTTLPR increased externalizing behavior in individuals with antisocial biologic parentage; a second interaction with one or more 5HTTLPR short variants (SS or SL) appeared to increase externalizing behaviors in conjunction with a genetic diathesis for alcoholism. Gender of adoptee also appeared to interact with 5HTTLPR. Male individuals with the short variant were more likely to have higher symptom counts for conduct disorder, aggressivity, and ADHD. In contrast, among females, the short variant (SS, SL) was associated with lower levels of such behavior. The results support the hypothesis that gene-biological family history interactions are involved in the externalizing behaviors studied and constitute interesting findings for future replication.

Training programme for parents of teenagers: active parental participation in development and implementation

In Sweden, all new parents should be offered parental training, but up until now, the programmes have been provided only within maternity and child healthcare, and they have been initiated and planned by central public authorities. We describe the process whereby a training programme for parents of teenagers was developed, in co-operation with the parents themselves, and we report the results of a brief questionnaire survey to the participating parents. A 'parents' school' was planned by 36 parents and a project leader, and between 14 and 26 parents participated in four planning meetings. Four lecture evenings, including group discussions, were arranged, a total of 105 parents registered their interest in participating, and between 50 and 70 attended each lecture. The majority of the parents reported being basically satisfied, feeling that they had acquired knowledge and insights about the teenage phase, and they wanted the 'parents' school' to continue.

A biopsychosocial model of the development of chronic conduct problems in adolescence

A biopsychosocial model of the development of adolescent chronic conduct problems is presented and supported through a review of empirical findings. This model posits that biological dispositions and sociocultural contexts place certain children at risk in early life but that life experiences with parents, peers. and social institutions increment and mediate this risk. A transactional developmental model is best equipped to describe the emergence of chronic antisocial behavior across time. Reciprocal influences among dispositions, contexts, and life experiences lead to recursive iterations across time that exacerbate or diminish antisocial development. Cognitive and emotional processes within the child, including the acquisition of knowledge and social-information-processing patterns, mediate the relation between life experiences and conduct problem outcomes. Implications for prevention research and public policy are noted.

Spanking children: the controversies, findings, and new directions

The use of spanking as a discipline technique is quite prevalent, even though whether or not to spank children is controversial among lay and professional audiences alike. Considerable research on the topic has been analyzed in several reviews of the literature that often reach different and sometimes opposite conclusions. Opposing conclusions are not inherently problematic as research develops in an area. However, we propose that both methodological limitations of the research to date as well as the limited focus of the research questions have prevented a better understanding of the impact of parental spanking on child development. The purpose of this article is to convey the basis for limited progress to date and, more importantly, to reformulate the research agenda. The goal is to move toward a resolution of the most relevant questions to parents, professionals, and policymakers. We propose an expanded research agenda that addresses the goals of parental discipline, the direct and concomitant effects of spanking, the influences that foster and maintain the use of spanking, and the processes through which spanking operates.

Obsessive-compulsive disorder in childhood and adolescence

Obsessive-compulsive disorder (OCD) is a common psychiatric condition during childhood and adolescence, which continues to be underestimated and undertreated. For these reasons, it constitutes a primary cause of major disabilities in those ages and, sometimes, of permanent impairments later on. In these last few years, childhood and adolescence OCD has attracted an increasing focus which has promoted a deeper awareness of this illness, a better recognition with earlier interventions, as well as the set-up of more tailored and specific strategies, including psychotropic drugs. The aim of this paper is to present a critical review of paediatric OCD, with a special attention towards the most compelling reports available up to now and towards the most interesting areas for future research.

A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors

BACKGROUND

Parent training is one of the most effective treatments for young children with conduct problems. However, not every family benefits from this approach and approximately one-third of children remain in the clinical range at follow-up assessments. Little is known about factors affecting treatment outcome for young children.

METHOD

Hierarchical linear modeling methods were used to examine the effects of child attentional risk factors (inattention, impulsivity and hyperactivity problems), parental and familial risk factors upon the efficacy of a parent training program to decrease boys' conduct problems. Mothers of 81 boys, four to seven years of age, exhibiting conduct problems attended a parent training program (The Incredible Years) which lasted 22 to 24 weeks. Treatment effectiveness was assessed at one month and one year post treatment by means of independent home observations, parent and teacher reports.

RESULTS

Results indicated significant decreases in observations of mothers' negative parenting interactions with their children and decreases in their conduct problems according to mother reports and independent observations at home. Boys with elevated ratings of attentional problems in addition to conduct problems showed similar benefits from the parent training program as the boys who did not have attentional problems.

CONCLUSION

This study suggests that parent training is equally effective for boys with both conduct problems and attentional problems as it is for boys with conduct problems without these attentional problems. In fact, boys rated in the Borderline or Clinical range for attentional problems evidenced a greater decrease in externalizing behavior problems as rated by their mothers. Surprisingly, the predictor variables of depression, stress, and socioeconomic status were not significant contributors at either initial status or growth over time whether outcomes were measured by child conduct problems or parenting interactions.