Mental disorders in current and former heavy ecstasy (MDMA) users

BACKGROUND

Ecstasy use has often been found to be associated with psychopathology, yet this research has so far been based largely on subjective symptom ratings.

AIMS

To investigate whether ecstasy users suffered from long-term psychopathological consequences.

MEASUREMENTS

We compared the prevalence of Diagnostic and Statistical Manual version IV (DSM-IV) mental disorders in 30 current and 29 former ecstasy users, 29 polydrug and 30 drug-naive controls. Groups were approximately matched by age, gender and level of education. The current ecstasy users reported a life-time dose of an average of 821 and the former ecstasy users of 768 ecstasy tablets.

FINDINGS

Ecstasy users did not significantly differ from controls in the prevalence of mental disorders, except those related to substance use. Substance-induced affective, anxiety and cognitive disorders occurred more frequently among ecstasy users than polydrug controls. The life-time prevalence of ecstasy dependence amounted to 73% in the ecstasy user groups. More than half of the former ecstasy users and nearly half of the current ecstasy users met the criteria of substance-induced cognitive disorders at the time of testing. Logistic regression analyses showed the estimated life-time doses of ecstasy to be predictive of cognitive disorders, both current and life-time.

CONCLUSIONS

The motivation for ecstasy use is not likely to be self-medication of pre-existing depressive or anxiety disorders as these did not occur more frequently in the ecstasy users than in control groups or in the general population. Cognitive disorders still present after over 5 months of ecstasy abstinence may well be functional consequences of serotonergic neurotoxicity of 3,4-methylenedioxymethamphetamine (MDMA).

Parental illness, family functioning, and adolescent well-being: a family ecology framework to guide research

A family ecology model for understanding adolescents' reactions to parental illness is presented and used to (a) critically evaluate existing research that examines direct effects of parental illness on family functioning and youth well-being and (b) provide a blueprint for future research in the area. Theoretical, clinical, and empirical literature is reviewed for each mediational and moderational pathway in the model, and limitations of the existing research are discussed. The blueprint for future research emphasizes a greater understanding of the mediational pathways in the model, which is essential for developing effective interventions for families experiencing parental illness. In addition, greater elucidation of moderator variables, such as the youth's developmental stage, social support, and cultural norms will provide critical information on contextual factors that enhance or impede adolescents' adaptation to serious parental illness.

Developmental trajectories of conduct problems and hyperactivity from ages 2 to 10

BACKGROUND

Conduct problems (CP) and hyperactivity/attention problems (HAP) are thought to covary with regularity, yet few studies have examined their co-occurrence or risk factors that discriminate their trajectories beginning in early childhood.

METHOD

The present study sought to advance our understanding of this issue by examining separate trajectories of overt CP and HAP symptomatology among 284 boys from urban, low-income families followed from ages 1.5 to 10. We also investigated the co-occurrence of persistent CP and HAP and explored risk factors that discriminate CP and HAP trajectories.

RESULTS

Four similar trajectory groups were identified for both CP and HAP symptoms. Chronic CP was differentiated from persistent low CP by risk factors in child, parenting, and family domains, while chronic trajectories of HAP were typified by elevated maternal depressive symptoms compared to children with persistent low HAP.

CONCLUSIONS

The findings extend previous research with older children of HAP and/or CP, highlighting the effects of proximal family and child risk factors that are identifiable in the first two years of children's lives and associated with trajectories of disruptive behavior.

Defining the “Disruptive” in Preschool Behavior: What Diagnostic Observation Can Teach Us

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.

Risk factors for community violence exposure in adolescence

Community violence is recognized a significant public health problem. However, only a paucity of research has examined risk factors for community violence exposure across domains relevant to adolescents or using longitudinal data. This study examined youth aggressive behavior in relation to community violence exposure among a community epidemiologically defined sample of 582 (45% female) urban adolescents. Internalizing behaviors, deviant peer affiliation, and parental monitoring were examined as moderators of the association between aggressive behavior and exposure to community violence. For males with aggressive behavior problems and deviant peer affiliation or low parental monitoring, co-occurring anxiety symptoms protected against subsequent witnessing community violence. In contrast, males with aggressive behavior problems and co-occurring depressive symptoms were at increased risk for witnessing community violence. Implications of the findings for preventive interventions and future research are discussed.

Children??s feelings toward parents in the context of parental disability

The purpose of the study was to examine the influence of parents' disability on children's feelings toward their parents. The paper focuses on the comparison of children's feelings toward their parents among school-age children with disabled parents (research group, n=45) and without disabled parents (control group, n=46). A two-dimensional approach was used. This approach is based on the assumption that positive and negative dimensions coexist relatively independently, rather than being polar opposites. The results show that positive and negative feelings toward parents coexist among most of the children in both the groups, but the general intensity of feeling toward parents and the discrepancy between the positive and the negative feeling were higher in the research group than in the control group. The research group was found to express more positive and ambivalent feelings and fewer negative and indifferent feelings than the control group. Moderator effects of age on these feelings in both groups were found as well. The implications of the research findings are discussed and future research is recommended.

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent-child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.

Beyond "healthy eating" and "healthy weights": harassment and the health curriculum in middle schools

In this paper we use data from interviews conducted with grades 7 and 8 girls to explore connections between body-based harassment and girls' body modification practices. We discuss how the elementary health curricula fail to consider harassment and other cultural factors that influence the body modification practices and eating patterns of diverse girls. More specifically, we argue that the "healthy eating, healthy weights" approach of the grades 7 and 8 Ontario health curriculum has five limitations: (1) it sends contradictory messages; (2) it increases anxieties about body weight; (3) it ignores the multiple causes of eating problems; (4) it marginalizes issues most relevant to racialized girls; and (5) it ignores dilemmas associated with physical development. We conclude with suggestions for developing a curriculum on body dissatisfaction and eating disorders prevention that considers the various socio-cultural factors influencing the range of body monitoring and modifying practices taken up by girls.

Risperidone reduces aggression in boys with a disruptive behaviour disorder and below average intelligence quotient: analysis of two placebo-controlled randomized trials

The present study aimed to analyse the effect of risperidone on a priori defined core aggression items. Data were pooled from 163 boys (aged 5-12 years, with or without comorbid attention-deficit/hyperactivity disorder) with a DSM-IV diagnosis of either conduct disorder or oppositional defiant disorder who had participated in either of two identical, 6-week, randomized, double-blind, placebo-controlled trials. All received treatment with either placebo or oral risperidone solution (0.01-0.06 mg/kg/day). Subjects had below average intelligence [intelligence quotient (IQ) 36-84] and a score of > or =24 on the Conduct Problem subscale of the Nisonger Child Behaviour Rating Form (N-CBRF). An expert advisory panel selected six core aggression items from the N-CBRF, from which a total Aggression Score (AS, range 0-18) was constructed. Compared to those treated with placebo, risperidone-treated subjects experienced significantly greater mean decreases from baseline in the AS at each of weeks 1-6 (P<0.001). By study endpoint, aggression among risperidone-treated subjects had declined by 56.4% (mean baseline AS 10.1; mean endpoint AS 4.4), which was more than twice that of placebo-treated subjects (mean baseline AS 10.6; mean endpoint AS 8.3; 21.7% reduction). Risperidone was efficacious in reducing symptoms of aggression in boys of below average IQ with disruptive behaviour disorders.

Influence of general self-efficacy on the effects of a school-based universal primary prevention program of depressive symptoms in adolescents: a randomized and controlled follow-up study

BACKGROUND

Depressive disorders in adolescents are a widespread and increasing problem. Prevention seems a promising and feasible approach.

METHODS

We designed a cognitive-behavioral school-based universal primary prevention program and followed 347 eighth-grade students participating in a randomized controlled trial for three months.

RESULTS

In line with our hypothesis, participants in the prevention program remained on a low level of depressive symptoms, having strong social networks. The control group showed increasing depressive symptoms and a reduced social network. Contrary to our expectations, students low in self-efficacy benefited more from the program than high self-efficient students. Social network did not mediate the relationship between participation in the prevention program and changes in depressive symptoms.

CONCLUSIONS

Our results show that the prevention program had favorable effects. Further research is needed to explore the impact of self-efficacy on the effects of prevention programs.

Family-based treatment research: a 10-year update

OBJECTIVE

To provide an update on the state of the art of family-based treatment research.

METHOD

Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves.

RESULTS

Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety.

CONCLUSIONS

For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

Communication and frightening behavior among couples with past and recent histories of physical marital aggression

The present study compares observed communication and couples' reports of husbands' frightening behaviors among couples with no history of husbands' physical marital aggression, a past history of such aggression, and recent history of such aggression. Ninety community couples reported on husbands' physical marital aggression during two visits to the lab, approximately 1.5 years apart. During the second visit, we videotaped couples' discussions of conflictual marital issues. Poor communication, as indexed by high hostility, low problem-description and low warmth, characterized couples with recent aggression, as compared to past aggression or no aggression. Husbands' frightening behavior characterized the couples with either recent or past aggression, compared to no aggression. In addition, for couples who had experienced severe aggression, the rates of husbands' frightening behavior were similar regardless of whether husbands persisted, reduced or desisted in the severe aggression. Discussion addresses possible reasons that reductions and desistance in husbands' aggression may be associated with more positive communication patterns but with continued reports of frightening behavior.

Ties that bind: Implications of social support for rural, partnered African American women’s health functioning

Ecological theory was used to explore the pathways through which intimate relationship quality influenced health functioning among rural, partnered African American women. Structural equation modeling was used to analyze data from 349 women in Georgia and Iowa. Women's intimate relationship quality was positively associated with their psychological and physical health functioning. Support from community residents moderated this link, which was strongest for women who felt most connected with their neighbors and for women who believed their neighborhood to have a sense of communal responsibility. Future research should identify other factors salient to health functioning among members of this population.

Patterns of posttraumatic stress symptoms in parents of childhood cancer survivors

Posttraumatic stress (PTS) symptoms have been reported in mothers and fathers of childhood cancer survivors; however, little is known about patterns of PTS in these families. Cluster analysis was applied to the Posttraumatic Stress Disorder (PTSD) Reaction Index scores of 98 couples parenting adolescent childhood cancer survivors to describe patterns of PTS in families, yielding the following 5 clusters: Minimal PTS, Mothers Elevated, Disengaged, Fathers Elevated, and Elevated PTS. The clusters were validated using data from a structured psychiatric interview, an additional self-report measure of PTS, and an index of family functioning. These clinically meaningful patterns reveal that a majority of families had at least one parent with moderate to severe PTS, which supports development of family-based interventions for this population.

Youth depression in the family context: familial risk factors and models of treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive-behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.

Cognitive modules utilized for narrative comprehension in children: a functional magnetic resonance imaging study

The ability to comprehend narratives constitutes an important component of human development and experience. The neural correlates of auditory narrative comprehension in children were investigated in a large-scale functional magnetic resonance imaging (fMRI) study involving 313 subjects ages 5-18. Using group independent component analysis (ICA), bilateral task-related components were found comprising the primary auditory cortex, the mid-superior temporal gyrus, the hippocampus, the angular gyrus, and medial aspect of the parietal lobule (precuneus/posterior cingulate). In addition, a right-lateralized component was found involving the most posterior aspect of the superior temporal gyrus, and a left-lateralized component was found comprising the inferior frontal gyrus (including Broca's area), the inferior parietal lobule, and the medial temporal gyrus. Using a novel data-driven analysis technique, increased task-related activity related to age was found in the components comprising the mid-superior temporal gyrus (Wernicke's area) and the posterior aspect of the superior temporal gyrus, while decreased activity related to age was found in the component comprising the angular gyrus. The results are discussed in light of recent hypotheses involving the functional segregation of Wernicke's area and the specific role of the mid-superior temporal gyrus in speech comprehension.

Cognitive behavioral and attachment based family therapy for anxious adolescents: Phase I and II studies

The goals of these two studies were to assess the acceptability and feasibility as well as to gather preliminary efficacy data on a modified combination cognitive behavioral (CBT) and attachment based family therapy (ABFT) for adolescents (ages 12-18), with the primary diagnosis of generalized (GAD), social phobia (SP), and separation (SAD) anxiety disorders. In Phase I, CBT was modified for an adolescent population and ABFT was modified for working with anxious adolescents in combination with CBT. Therapists were trained for both conditions and eight patients were treated as an open trial pilot of combined CBT-ABFT with positive results. In Phase II, 11 adolescents were randomly assigned to CBT alone or CBT and family based treatment (CBT-ABFT). Participants were evaluated at pre, post, and 6-9 months follow-up assessing diagnosis, psychiatric symptoms and family functioning. Results indicated significant decreases in anxiety and depressive symptoms by both clinical evaluator and self-reports with no significant differences by treatment. Sixty-seven percent of adolescents in CBT no longer met criteria for their primary diagnosis at post treatment as compared to 40% in CBT-ABFT with continued improvement of 100 and 80% at follow-up with no significant differences between treatments. Both CBT and CBT-ABFT appear to be promising treatments for anxious adolescents and more treatment development and evaluation is needed.

Children with oppositional-defiant disorder display deviant attentional processing independent of ADHD symptoms

OBJECTIVE

To examine neurophysiological correlates of attentional processing in children with oppositional-defiant disorder (ODD) independent of ADHD symptoms.

METHOD

Thirteen children with oppositional-defiant disorder without comorbid ADHD symptoms and 13 healthy control children (all 11 years) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials (ERP) to cue and target stimuli were examined for group differences.

RESULTS

Children with ODD showed significantly reduced parietal P3a and P3b amplitudes to cues and to targets, compared with healthy controls. ERP amplitudes correlated with oppositional and aggressive behavior scores.

CONCLUSIONS

Event-related potentials revealed reduced orienting to cues and reduced executive target processing in children with ODD. These findings indicate that ODD children show neurophysiological deviances independent of ADHD comorbidity.

Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women

This paper provides a summary of the current conceptualization of what AD/HD is, and its etiology, and then reviews some of the recent literature on the correlates and lifecourse outcomes for individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD). The intention is to synthesize that which is known, and to identify important gaps in the literature and knowledge base, which secondary analysis of prospective large-scale longitudinal cohorts, tracking individuals from birth to adulthood, could help to fill. This review highlights the fact that such datasets are rare and that their analysis offers important opportunities for advancing knowledge, particularly of the adult outcomes of childhood AD/HD.

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.

Development of a school-based treatment program for middle school youth with ADHD

The authors conduct an evaluation of a middle school-based treatment program for youth with ADHD during early stages of treatment development. The studies focus on interpreting outcome trends in preliminary data and identifying assessment issues that will be important to consider when conducting a clinical trial. Parent reports indicate that the majority of students benefit from improvements in academic, social, and overall functioning. Although teachers report beneficial effects for the majority of the participants in the program, there is little agreement about individual students. Measurement problems are associated with understanding normal change during a school year, accounting for normal behavior changes in December and May, and considerable disagreement between teachers. Suggestions to guide future work in this area are provided.

Motor flexibility problems as a marker for genetic susceptibility to attention-deficit/hyperactivity disorder

BACKGROUND

Since many children with attention-deficit/hyperactivity disorder (ADHD) have fine visuomotor problems that are already evident at a young age, motor dysfunctioning is investigated in family-genetic perspective. We hypothesized that if fine motor problems may be a marker for genetic susceptibility to ADHD, nonaffected siblings of ADHD probands would experience motor problems similar to those of their ADHD siblings.

METHODS

Twenty-five carefully phenotyped ADHD probands with a family history of ADHD, their nonaffected siblings (n = 25), and 48 normal control subjects (aged 6 to 17) completed a motor fluency task and a motor flexibility task. The motor fluency task involved completion of a familiar, automatized trajectory, whereas the motor flexibility task required continuous adjustment of movement to complete an unpredictable random trajectory.

RESULTS

On the motor fluency task, the performance of the nonaffected children was significantly better than that of the ADHD probands; strikingly, on the motor flexibility task, they performed as well as their ADHD siblings.

CONCLUSIONS

Nonaffected siblings experience complex motor problems similar to their ADHD siblings but only in nonautomatized movements that require controlled processing. The results suggest that higher-order controlled motor deficits in ADHD may be associated with genetic susceptibility for ADHD.

Service needs of families with children with ADHD

This article describes service use, perceived helpfulness of services, and the services requested of 157 families living with a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) and specifically asks if service use and service need is a function of certain social demographic factors. Whereas these data suggest that ADHD is a fairly universal experience, as indicated by the high rate of service use across ethnic groups, income status, sex, and family composition, single-mother families used the most services, Hispanic families used the fewest, and families with boys with ADHD used more services than families with girls with ADHD. Income was not a significant factor in any services used or services requested. This study lends strength to the argument that more specialized services for certain groups are needed in venues with local community services, such as schools, where the majority of these children and families are already seeking help.

Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The Deployment-Focused Model of Intervention Development and Testing has been proposed as a promising method of bridging the gap between research and practice settings. A key aspect of the model is to involve the persons most likely to deliver the service (e.g., teachers) in the intervention development process from the very beginning. To illustrate this process, the authors describe the planning and implementation of a school-wide program designed to improve behavior in a public middle school.

Evidence-Based Assessment of Child and Adolescent Disorders: Issues and Challenges

The main purpose of this article and this special section is to encourage greater attention to evidence-based assessment (EBA) in the development of a scientifically supported clinical child and adolescent psychology. This increased attention is especially important in light of (a) the omission of assessment considerations in recent efforts to promote evidence-based treatments for children and (b) ongoing changes in the nature of clinical child assessment. We discuss several key considerations in the development of guidelines for EBA, including the purposes of assessment, the role of disorder or problem specificity, the scope of assessment, assessment process parameters, possible "cross-cutting" assessment issues, psychometric considerations, and issues related to the clinician's integration of assessment data. We conclude the article with suggestions for how current, summary information on EBA can be developed, maintained, and disseminated.

Child maltreatment prevention priorities at the Centers for Disease Control and Prevention

The Division of Violence Prevention at Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control has had a long-standing interest in the prevention of child maltreatment. The nation's public health agency, CDC, seeks to focus the public health perspective on the problem of child maltreatment and to promote science-based practice in the field. Since 1999, CDC has developed research priorities to address the prevention of child maltreatment. Described here is a brief rationale for applying a public health approach to child maltreatment and a discussion of the priority-setting process, priorities in each of four areas of the public health model, and some of CDC's current child maltreatment prevention activities.

Youths and HIV/AIDS: psychiatry's role in a changing epidemic

OBJECTIVE

To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments.

METHOD

Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment.

RESULTS

Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems.

CONCLUSIONS

HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Implementation of a comprehensive schoolwide behavioral intervention: The ABC program

The Academic and Behavioral Competencies (ABC) Program, a schoolwide program to reduce classroom disruption and encourage rule following, academic task completion, and homework completion, is described. The program was initially developed and implemented in an elementary school with a high-risk population. Data from teachers, parents, and children indicate high levels of satisfaction with the program. In addition, unobtrusive measures of program impact, reported as reductions in referrals to the principal's office, suspensions, and increases in homework completion rates relative to the year prior to implementation of the program, suggest a preliminary positive impact of the program. A replication is reported for another school district, with teacher evaluations of satisfaction and effectiveness reported, supporting the flexibility and adaptability of the program. Although the present article does not constitute a systematic evaluation of the ABC Program, it presents preliminary data on the process of implementation and stakeholder satisfaction.

Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood

OBJECTIVE

To study early childhood predictors for early adulthood psychiatric disorders.

METHOD

The sample included 2,712 Finnish boys born in 1981. Information about the 8-year-old boys' problem behavior was obtained from parents, teachers, and children. The 10-15-year follow-up information about psychiatric disorders in early adulthood was based on the national military register between the years 1999 and 2004.

RESULTS

According to the military register, 10.4% of men had a psychiatric disorder. All informant sources, parents, teachers, and the children themselves predicted early adulthood psychiatric disorders. Conduct symptoms at age 8 independently predicted substance abuse, antisocial personality, and psychotic disorders in early adulthood. Self-reported depressive symptoms, poor school performance, and living in a nonintact family had an independent predictive association with antisocial personality and depressive disorders. Parent-reported emotional symptoms and self-reported psychosomatic symptoms independently predicted anxiety disorders. About one third of those who had used services at age 8 had a psychiatric disorder in early adulthood. Among service users, conduct and hyperkinetic symptoms predicted psychiatric disorders in early adulthood.

CONCLUSIONS

Efforts to prevent early adult psychiatric disturbance already present in childhood are emphasized. Active screening to detect children in need of early interventions in childhood to prevent negative development in early adulthood is justified.

School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome

This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting evidence-based treatments to community settings and for integrating mental health services into the culture of the school community.

Cross-cultural comparison of the neurobehavioral characteristics of Chinese and Japanese neonates

BACKGROUND

Similarities and differences in the neurobehavioral repertoire of neonates from different cultures have been noted using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). By identifying the behavioral attributes of newborns that are seen more universally versus those that are culture-specific, comparative studies increase understanding of the roles of cultural factors in shaping the behavioral trajectory of infants. This study compared the neurobehavioral characteristics of neonates in Chengdu, China and Nagasaki, Japan.

METHODS

The Brazelton NBAS was administered within the first week of life to 40 Chinese and 62 Japanese healthy, full-term neonates in Chengdu and Nagasaki.

RESULTS

The two groups differed significantly in birthweight, gender, age at time of exam, mode of delivery, and gestational age. When these variables, in addition to group status (Chinese or Japanese), were entered into multiple linear analyses with NBAS cluster scores as dependent variables, group status independently predicted Range of State and Habituation scores. The group status did not predict Orientation, Motor, Regulation of States, Autonomic Stability, and Abnormal Reflexes cluster scores.

CONCLUSION

These results suggest that Japanese newborns habituated more readily to stimuli, and were less irritable than newborns in the Chinese sample. The infants in the two groups shared many similar neurobehavioral characteristics as well. The implications of these similarities and differences were discussed.

Evidence-Based Assessment of Conduct Problems in Children and Adolescents

This article provides a summary of research in 4 areas that have direct and important implications for evidence-based assessment of children and adolescents with conduct problems (CP): (a) the heterogeneity in types and severity of CP, (b) common comorbid conditions, (c) multiple risk factors associated with CP, and (d) multiple developmental pathways to CP. For each of these domains, we discuss implications for evidence-based assessment, present examples of specific measures that can aid in such assessments, and provide recommendations for evidence-based assessment of CP in children and adolescents. We conclude that there is a need to (a) enhance the clinical utility of evidence-based measures for assessing CP; (b) increase attention to the sensitivity of such measures to change, for both treatment evaluation and monitoring; and (c) develop assessment methods that reliably and validly identify a child or adolescent's placement and progress on the various developmental pathways to CP.

Chemical dependency and psychiatric services for adolescents in private managed care: implications for outcomes

BACKGROUND

Many adolescents with alcohol and drug problems have mental health comorbidities. The literature suggests that patients entering chemical dependency (CD) treatment with co-occurring problems have less successful outcomes, including treatment dropout and relapse. We examined the impact of psychiatric services on treatment initiation, retention, and alcohol and drug abstinence outcomes for adolescents in CD treatment.

METHODS

Participants were 419 adolescents aged 12-18 years who were seeking treatment at four CD programs of a nonprofit, managed care, group model health system and a parent or guardian for each adolescent. We surveyed participants at intake and 6 months and examined clinical and administrative data on diagnoses and CD and psychiatric utilization. Six-month response rates were 91% for adolescents and 93% for parents.

RESULTS

Fifty-five percent of the patients with treatment intakes had at least one psychiatric diagnosis in addition to a substance use disorder. Compared with matched controls, patients with CD intakes had higher rates of depression, anxiety, eating disorders, attention deficit hyperactivity disorder, conduct disorder, and conduct disorder including oppositional defiant disorder. Thirty-one percent of the full sample had psychiatric visits in the 6 months after intake; among those with a psychiatric diagnosis, 54% had a psychiatric visit. Girls and those with higher Youth Self-Report internalizing scores were more likely to have a psychiatric visit (OR = 2.27, p < 0.001 and OR = 1.05, p < 0.0001, respectively). Adolescents receiving psychiatric services were more likely to be abstinent from both alcohol and drugs than those not receiving these services (OR = 1.57, 95% CI = 0.98-2.5) and more likely to be alcohol abstinent (OR = 1.68, 95% CI = 1.00-2.85). Those adolescents at colocated clinics had higher odds of abstinence from both alcohol and drugs (OR = 1.57, 95% CI = 1.03-2.39) and drugs (OR = 1.84, 95% CI = 1.87-2.85) and of returning after intake to initiate CD treatment (OR = 2.28, 95% CI = 1.44-3.61, p < 0.001) than others.

CONCLUSIONS

Our results demonstrate the need for psychiatric treatment of adolescents in CD treatment and highlight the importance of their receiving such services.

Predictors of Engagement and Retention into a Parent-Centered, Ecodevelopmental HIV Preventive Intervention for Hispanic Adolescents and their Families

OBJECTIVE

This study examined predictors of engagement and retention into a parent-centered, ecodevelopmental HIV preventive intervention for Hispanic adolescents and their families. The influence of retention on changes in adolescent HIV-risk attitudes was also examined.

METHODS

Participants in this study were 91 Hispanic adolescents and their primary parents. Structural equation modeling was used to identify (a) predictors of initial engagement, (b) the effects of group processes on retention, and (c) the effects of retention on change HIV-risk attitudes in adolescents.

RESULTS

Although some participant characteristics predicted engagement, the parent-facilitator relationship quality at the initial contact was found to be the strongest predictor of engagement. Furthermore, within-group processes such as group cohesion positively predicted retention. Finally, parent retention predicted decreases in adolescent HIV-risk attitudes.

CONCLUSIONS

The results may have important implications for engagement and retention in parent-centered interventions, as well as for reducing risks for HIV transmission in Hispanic adolescents. Implications for services research are also discussed.

Attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a disorder of inattention, impulsivity, and hyperactivity that affects 8-12% of children worldwide. Although the rate of ADHD falls with age, at least half of children with the disorder will have impairing symptoms in adulthood. Twin, adoption, and molecular genetic studies show ADHD to be highly heritable, and other findings have recorded obstetric complications and psychosocial adversity as predisposing risk factors. Converging evidence from animal and human studies implicates the dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits in the pathophysiology of ADHD, and molecular imaging studies suggest that abnormalities of the dopamine transporter lead to impaired neurotransmission. Studies during the past decade have shown the safety and effectiveness of new non-stimulant drugs and long-acting formulations of methylphenidate and amfetamine. Other investigations have also clarified the appropriate role of targeted psychosocial treatments in the context of ongoing pharmacotherapy.

A theoretical model of common process factors in youth and family therapy

Recently there has been an increasing emphasis in the youth and family mental health treatment literature on the use of empirically supported treatments (ESTs). In contrast there has been scant attention paid to more universal aspects of the therapy process that may have even greater impact upon therapy outcomes. It is likely that the success of the techniques proposed by ESTs may depend on the presence of common process factors. In this article, the authors explore the status of common process factors research in the youth and family therapy literature, and propose a theoretical model linking specific therapeutic relationship variables and treatment outcomes for children and adolescents. This model is intended to guide synthesis of the empirical evidence for common process factors in youth and family treatment and to stimulate future research on common process factors.

Measuring adherence to treatment of paediatric HIV/AIDS

Parent, child, physician report and pill counts were used to measure adherence in paediatric HIV. Relationships to viral load were assessed. Pill counts were considered invalid. Adherence measures did not correlate with one another. Physicians reported lower adherence than parents, but parent and physician report correlated with viral load. The clinical and research utility of the various measures are discussed.

Intraindividual variability of school bonding and adolescents' beliefs about the effect of substance use on future aspirations

The study examines the dynamic relationship between school bonding, beliefs about the deleterious effects of substance use on future aspirations, and subsequent substance use among a sample of 1065 male and female middle school students. First, a mediation model was assessed. Adolescents' perceptions about the harmful effects of substance use on their future aspirations emerged as a salient mediator of the relationship between school bonding and subsequent substance use. Second, the intraindividual variability of school bonding and its effect on students' beliefs about the potential harm of substance use on future aspirations was assessed through random-coefficient models. Students who tended to be poorly bonded to school were less likely to perceive that substance use may impede the attainment of their future goals. Furthermore, a strong intraindividual effect of school bonding was observed, indicating that as a student became more or less bonded to school his/her belief that substance use could affect future aspirations similarly changed.

Impact, psychological sequelae and management of trauma affecting children and adolescents

PURPOSE OF REVIEW

In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments.

RECENT FINDINGS

Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms.

SUMMARY

Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.

Youths living away from families in the US mental health system

This study examines the clinical characteristics of youths who lived away from families at the time of admission to specialty mental health services, and investigates the association between type of nonfamily living situation and admission to residential versus outpatient programs. Of 3995 youths sampled from 1598 mental health programs in the United States, 14% lived away from their own families, either in foster care, group care settings, or correctional settings, or were emancipated. As a group, youths living away from families were more seriously emotionally disturbed and more likely to receive treatment in residential care programs. Youths who lived in foster care were more likely to be admitted to outpatient programs, while youths who lived in group care settings or correctional settings were more likely to be admitted to residential care programs, controlling on demographic and clinical characteristics. Targeting resources to enhance the availability and therapeutic capacity of foster care may facilitate community living, and decrease time spent in institutional settings.

Parenting and the development and prevention of child mental health problems

PURPOSE OF REVIEW

The government is recognizing the need to deal with the growing numbers of antisocial young people through investing in early preventive parenting support. It is important that the services provided are evidence-based and delivered effectively. This review briefly discusses the contribution of parenting to the development of child mental health difficulties, particularly externalizing problems, and reviews some effective early intervention preventive programmes.

RECENT FINDINGS

Over 30 years of research have established both that parenting behaviours influence the development of childhood conduct disorders and that behavioural family interventions targeting specific parenting skills are the most effective way of preventing or reducing child behaviour problems. Until recently, however, those children at highest risk have often had the poorest outcomes from intervention. Recent research has identified the factors that make parenting interventions effective and how to engage the multi-stressed, hard-to-reach families whose children are most at risk.

SUMMARY

Research has identified risk factors that are associated with the development of conduct disorder and affect the quality of parenting. This has made it possible to provide preventive interventions, targeting families that are most at risk. Evaluations have shown, however, that getting effective preventive services to those most at risk is not straightforward and programmes need to address the problem of recruiting parents who, by virtue of their multiple problems, have traditionally been hard to engage. Emphasis is placed on the importance of using evidenced-based programmes in service settings in ways that are effective.