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Cosby M, Shah DD, Lopez S, Holland-Cecil J, Keiter M, Lewis C, Al-Mateen CS. All Shades of Anxiety: A Review of Therapeutic and Psychotropic Considerations for Child and Adolescent Youth of Color. Child Adolesc Psychiatr Clin N Am 2023; 32:631-653. [PMID: 37201972 DOI: 10.1016/j.chc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The literature on anxiety in Black, Indigenous, and other persons of color youth is a developing area. This article highlights distinct areas for the clinician to consider in working with these populations. We highlight prevalence and incidence, race-related stress, social media, substance use, spirituality, the impact of social determinants of health (including COVID-19 and the Syndemic), as well as treatment considerations. Our aim is to contribute to the readers' developing cultural humility.
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Affiliation(s)
- Michele Cosby
- Department of Psychiatry, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23220, USA.
| | - Dimal D Shah
- Department of Psychiatry, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23220, USA
| | - Stella Lopez
- Virginia Treatment Center for Children VCU Health, Richmond, VA, USA
| | | | | | | | - Cheryl S Al-Mateen
- Department of Psychiatry, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23220, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
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2
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Sadler RC, Felton JW, Rabinowitz JA, Powell TW, Latimore A, Tandon D. Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion. URBAN PLANNING 2022; 7:153-166. [PMID: 37033410 PMCID: PMC10081151 DOI: 10.17645/up.v7i4.5410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long-term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important.
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Affiliation(s)
- Richard C. Sadler
- Division of Public Health, Michigan State University, USA
- Department of Family Medicine, Michigan State University, USA
| | - Julia W. Felton
- Center for Health Policy & Health Services Research, Henry Ford Health System, USA
| | - Jill A. Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Terrinieka W. Powell
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Amanda Latimore
- Johns Hopkins Bloomberg School of Public Health, USA
- Center for Addiction Research and Effective Solutions, USA
| | - Darius Tandon
- Center for Community Health, Northwestern University Feinberg School of Medicine, USA
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Caplan B, Lind T, Chlebowski C, Martinez K, May GC, Alvarado CJG, Brookman-Frazee L. Training Community Therapists in AIM HI: Individual Family and Neighborhood Factors and Child/Caregiver Outcomes. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-13. [PMID: 35881774 PMCID: PMC9877246 DOI: 10.1080/15374416.2022.2096046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Publicly funded mental health services play an important role in caring for children with mental health needs, including children with autism spectrum disorder (ASD). This study assessed the associations between individual family- and neighborhood-level sociodemographic factors and baseline family functioning and long-term outcomes when community therapists were trained to deliver An Individualized Mental Health Intervention for ASD (AIM HI). METHOD Participants included 144 children with ASD (ages 5 to 13 years; 58.3% Latinx) and their caregivers whose therapists received AIM HI training within a cluster-randomized effectiveness-implementation trial in publicly funded mental health services. Sociodemographic strain (e.g., low income, less education, single-parent status, minoritized status) was coded at the individual family and neighborhood level, and caregivers rated caregiver strain at baseline. Child interfering behaviors and caregiver sense of competence were assessed at baseline and 6-, 12- and 18-months after baseline. RESULTS Higher caregiver strain was associated with higher intensity of child behaviors (B = 5.17, p < .001) and lower caregiver sense of competence (B = -6.59, p < 001) at baseline. Child and caregiver outcomes improved over time. Higher caregiver strain (B = 1.50, p < .001) and lower family sociodemographic strain (B = -0.58, p < .01) were associated with less improvements in child behaviors. Lower caregiver strain (B = -2.08, p < .001) and lower neighborhood sociodemographic strain (B = -0.51, p < .01) were associated with greater improvements in caregiver sense of competence. CONCLUSIONS Findings corroborate the importance of considering both family and neighborhood context in the community delivery of child-focused EBIs. TRIAL REGISTRATION Clinical Trials NCT02416323.
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Affiliation(s)
- Barbara Caplan
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- University of California, San Diego, Department of Psychiatry, San Diego, CA, USA
| | - Teresa Lind
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- San Diego State University, Department of Child and Family Development, San Diego, CA, USA
| | - Colby Chlebowski
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- University of California, San Diego, Department of Psychiatry, San Diego, CA, USA
| | - Kassandra Martinez
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- University of California, San Diego, Department of Psychiatry, San Diego, CA, USA
| | - Gina C. May
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, NE, USA
| | | | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
- University of California, San Diego, Department of Psychiatry, San Diego, CA, USA
- Rady Children’s Hospital – Autism Discovery Institute, San Diego, CA, USA
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Last BS, Rudd BN, Gregor CA, Kratz HE, Jackson K, Berkowitz S, Zinny A, Cliggitt LP, Adams DR, Walsh LM, Beidas RS. Sociodemographic characteristics of youth in a trauma focused-cognitive behavioral therapy effectiveness trial in the city of Philadelphia. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1273-1293. [PMID: 31872896 PMCID: PMC7261621 DOI: 10.1002/jcop.22306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/25/2019] [Accepted: 12/05/2019] [Indexed: 05/13/2023]
Abstract
While randomized controlled trials of trauma-focused cognitive behavioral therapy (TF-CBT) have demonstrated efficacy for youth with posttraumatic stress disorder, TF-CBT effectiveness trials typically show attenuated outcomes. This decrease in effectiveness may be due to the differences in sociodemographic characteristics of youth in these trials; youth in efficacy trials are more often white and middle-income, whereas youth in effectiveness trials are more often racial/ethnic minorities, of low socioeconomic status (SES) and live in high crime neighborhoods. In this study-drawn from an effectiveness trial of TF-CBT in community mental health clinics across Philadelphia-we describe the sociodemographic characteristics of enrolled youth. We measured neighborhood SES by matching participants' addresses to American Community Survey data from their Census tracts, housing stability using the National Outcomes Measurement System, and neighborhood violence using police department crime statistics. Our results suggest that the majority of youth presenting for TF-CBT in mental health clinics in the City of Philadelphia live in poor and high-crime neighborhoods, experience substantial housing instability, and are predominantly ethnic and racial minorities. Thus, youth presenting for treatment experience significant racial and socioeconomic adversity. We also explored the association between these characteristics and youth symptom severity upon presenting for treatment. These factors were not associated with youth symptom severity or overall mental health functioning in our sample (with small effect sizes and p > .05 for all). Implications for future research, such as the need for efficacy and effectiveness trials to more fully characterize their samples and the need for pragmatic trials are discussed.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, School of Arts and Sciences, The University of Pennsylvania
| | - Brittany N. Rudd
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
| | - Courtney A. Gregor
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
| | | | | | | | | | | | | | | | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania
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5
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Muris P, Ollendick TH. Children Who are Anxious in Silence: A Review on Selective Mutism, the New Anxiety Disorder in DSM-5. Clin Child Fam Psychol Rev 2016; 18:151-69. [PMID: 25724675 DOI: 10.1007/s10567-015-0181-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Selective mutism (SM) is a relatively rare childhood disorder characterized by a consistent failure to speak in specific settings (e.g., school, social situations) despite speaking normally in other settings (e.g., at home). The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists SM among the anxiety disorders. This makes sense as the current review of the literature confirms that anxiety is a prominent symptom in many children suffering from this condition. Further, research on the etiology and treatment of SM also corroborates the conceptualization of SM as an anxiety disorder. At the same time, critical points can be raised regarding the classification of SM as an anxiety disorder. We explore a number of such issues in this review. Recommendations for dealing with this diagnostic conundrum are made for psychologists, psychiatrists, and other mental health workers who face children with SM in clinical practice, and directions for future research are highlighted.
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Affiliation(s)
- Peter Muris
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
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Chen MH, Tsai SJ. Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:219-26. [PMID: 26850787 DOI: 10.1016/j.pnpbp.2016.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Kendall PC, Makover H, Swan A, Carper MM, Mercado R, Kagan E, Crawford E. What steps to take? How to approach concerning anxiety in youth. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taylor JJ, Grant KE, Zulauf CA, Fowler PJ, Meyerson DA, Irsheid S. Exposure to Community Violence and the Trajectory of Internalizing and Externalizing Symptoms in a Sample of Low-Income Urban Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:421-435. [PMID: 27219899 DOI: 10.1080/15374416.2016.1152553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined trajectories of psychopathology in a sample of low-income urban youth and tested exposure to community violence as a predictor of these trajectories. Self-report and parent-report survey measures of psychological problems and exposure to community violence were collected annually over 3 years from a sample of 364 fifth- to ninth-grade low-income urban youth (64% female; 95% youth of color). Linear growth models showed that youth experienced declines in both internalizing and externalizing symptoms across adolescence. Exposure to community violence was more strongly associated with externalizing symptoms than with internalizing symptoms but predicted declines in both types of symptoms. Results also indicated that youth reported more internalizing and externalizing symptoms than their parents reported for them. Exposure to community violence may explain unique trajectories of mental health problems among low-income urban youth. In addition, youth efforts to adopt a tough façade in the face of community violence could lead to higher rates of externalizing problems relative to internalizing problems, whereas desensitization processes may better explain reductions in both types of symptoms over time. Finally, youth report may be more valid than parent report in the context of urban poverty.
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Affiliation(s)
- Jeremy J Taylor
- a Assessment and Continuous Improvement , Collaborative for Academic, Social, and Emotional Learning
| | | | | | - Patrick J Fowler
- d George Warren Brown School of Social Work , Washington University in St. Louis
| | | | - Sireen Irsheid
- f Harlem Children's Zone - Promise Academy Charter School
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Ringle VA, Read KL, Edmunds JM, Brodman DM, Kendall PC, Barg F, Beidas RS. Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatr Serv 2015; 66:938-45. [PMID: 25975886 PMCID: PMC4869696 DOI: 10.1176/appi.ps.201400134] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study examined, from the perspective of therapists, the barriers to and facilitators in implementing cognitive-behavioral therapy (CBT) for anxious youths in community settings. METHODS Fifty therapists (43% of the original training sample of 115 providers) participated in a follow-up interview two years after training and consultation. They reported on barriers to and facilitators in implementation of CBT for youths with anxiety. RESULTS Qualitative analyses identified numerous barriers and facilitators, including client factors (for example, motivated clients facilitated the use of CBT, whereas clients with complex issues and numerous psychosocial stressors hindered its use), intervention factors (the structure of CBT helped facilitate its use for some providers, whereas others reported feeling constrained by such structure), and organizational factors (for example, the absence of support within one's institution served as a barrier, whereas supervision supporting the use of CBT facilitated implementation). CONCLUSIONS Findings of this implementation trial align with conceptual implementation frameworks and may guide the tailoring of future implementation efforts in order to overcome barriers and maximize facilitators.
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Affiliation(s)
- Vanesa A Ringle
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kendra L Read
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julie M Edmunds
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Douglas M Brodman
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Philip C Kendall
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances Barg
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rinad S Beidas
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
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Beidas RS, Edmunds J, Ditty M, Watkins J, Walsh L, Marcus S, Kendall P. Are inner context factors related to implementation outcomes in cognitive-behavioral therapy for youth anxiety? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:788-99. [PMID: 24202067 PMCID: PMC4014529 DOI: 10.1007/s10488-013-0529-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among the challenges facing the mental health field are the dissemination and implementation of evidence-based practices. The present study investigated the relationships between inner context variables (i.e., adopter characteristics and individual perceptions of intra-organizational factors) and two implementation outcomes-independently rated therapist fidelity on a performance-based role-play (i.e., adherence and skill) and self-reported penetration of cognitive behavioral therapy for youth anxiety following training. A significant relationship was found between inner context variables and fidelity. Specifically, adopter characteristics were associated with adherence and skill; individual perceptions of intra-organizational factors were associated with adherence. Inner context variables were not associated with penetration. Future directions are discussed.
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Affiliation(s)
- Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania
Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA,
215-746-1759,
| | - Julie Edmunds
- Center for Effective Child Therapy, Judge Baker
Children’s Center, Boston, MA
| | - Matthew Ditty
- School of Social Policy and Practice, University of
Pennsylvania, Philadelphia, PA
| | | | - Lucia Walsh
- Department of Psychiatry, University of Pennsylvania
Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA,
215-746-1759,
| | - Steven Marcus
- School of Social Policy and Practice, University of
Pennsylvania, Philadelphia, PA
- Center for Health Equity Research and Promotion,
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Philip Kendall
- Department of Psychology, Temple University, Philadelphia,
PA
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Abstract
Selective mutism (SM) is a relatively uncommon disorder in childhood, occurring in only 0.3 to 1.8 children per thousand. In early childhood, diagnosing SM can be particularly challenging, and the condition often goes unrecognized until the school years. Given the potential comorbidity of anxiety and communication deficits, treatment can be challenging and attendance in early childhood educational programs allows intervention in a contextually sensitive way that may also help address comorbidities and promote generalization. Thus, this case study of an African American preschool boy highlights the unique obstacles and opportunities of assessment and treatment in a preschool setting. Furthermore, we describe a three-step behavioral approach to addressing SM in collaboration with educators over a 3-month period. Substantive research indicates that early intervention with SM is associated with decreased likelihood of developing an anxiety-related disorder later in childhood; therefore, tailored assessment and intervention in early childhood within a community-based setting may be extremely useful.
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12
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Beidas RS, Lindhiem O, Brodman DM, Swan A, Carper M, Cummings C, Kendall PC, Albano AM, Rynn M, Piacentini J, McCracken J, Compton SN, March J, Walkup J, Ginsburg G, Keeton CP, Birmaher B, Sakolsky D, Sherrill J. A probabilistic and individualized approach for predicting treatment gains: an extension and application to anxiety disordered youth. Behav Ther 2014; 45:126-36. [PMID: 24411120 PMCID: PMC3893713 DOI: 10.1016/j.beth.2013.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/28/2013] [Accepted: 05/05/2013] [Indexed: 11/15/2022]
Abstract
The objective of this study was to extend the probability of treatment benefit method by adding treatment condition as a stratifying variable, and illustrate this extension of the methodology using the Child and Adolescent Anxiety Multimodal Study data. The probability of treatment benefit method produces a simple and practical way to predict individualized treatment benefit based on pretreatment patient characteristics. Two pretreatment patient characteristics were selected in the production of the probability of treatment benefit charts: baseline anxiety severity, measured by the Pediatric Anxiety Rating Scale, and treatment condition (cognitive-behavioral therapy, sertraline, their combination, and placebo). We produced two charts as exemplars which provide individualized and probabilistic information for treatment response and outcome to treatments for child anxiety. We discuss the implications of the use of the probability of treatment benefit method, particularly with regard to patient-centered outcomes and individualized decision-making in psychology and psychiatry.
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