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Reflections on the Field of School Attendance Problems: For the Times They Are a-Changing? COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Selective mutism can be a potentially debilitating mental disorder that affects about 1% of youth. Unfortunately, this population remains under-researched, and very little information is available regarding the treatment of diverse youth with selective mutism. This article reports on the successful treatment of a 10-year-old Hispanic female with selective mutism. Treatment was largely behavioral in nature and consisted of exposure-based practices and contingency management.
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Barrington J, Prior M, Richardson M, Allen K. Effectiveness of CBT Versus Standard Treatment for Childhood Anxiety Disorders in a Community Clinic Setting. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.22.1.29.66786] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe efficacy of cognitive—behavioural therapy (CBT) for the treatment of childhood anxiety has mainly been demonstrated in university-clinic settings. This study aimed to evaluate the effectiveness of CBT for the treatment of childhood anxiety in a community mental health service, compared with standard treatments (‘Treatment as Usual’ [TAU]) 'child psychotherapy, family therapy and eclectic treatments. Fifty-four children with anxiety disorders, aged from 7 to 14 years, were randomly assigned to either a CBT or TAU group. CBT and the standard treatments were provided by 18 experienced therapists, and the mean number of treatment sessions was 12. Baseline and follow-up measures at 3, 6 and 12 months included an interview based on criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that was conducted by a clinical psychologist who was blind to the treatment conditions, and standardised anxiety measures (parent, child and teacher reports). Significant improvements were found on all anxiety measures over time, but no significant differences were found between CBT and TAU. The challenge of conducting such research in community settings is discussed.
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Macias C, Gold PB, Hargreaves WA, Aronson E, Bickman L, Barreira PJ, Jones DR, Rodican CF, Fisher WH. Preference in random assignment: implications for the interpretation of randomized trials. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:331-42. [PMID: 19434489 PMCID: PMC2796239 DOI: 10.1007/s10488-009-0224-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often assignment preference might have complicated the interpretation of findings. Condition descriptions, and greater early attrition from services-as-usual comparison conditions, suggest that many study enrollees favored assignment to new rapid-job-placement supported employment, but no study took this possibility into account. Reviews of trials in other service fields are needed to determine whether this design problem is widespread.
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Affiliation(s)
- Cathaleene Macias
- Community Intervention Research, McLean Hospital, Belmont, MA 02478, USA,
| | - Paul B. Gold
- Department of Counseling and Personnel Services, University of Maryland, College Park, MD 20742, USA,
| | | | - Elliot Aronson
- Department of Psychology, University of California, Santa Cruz, CA, USA,
| | - Leonard Bickman
- Center for Evaluation and Program Improvement, Vanderbilt University, Nashville, TN, USA,
| | - Paul J. Barreira
- Harvard University Health Services, Harvard University, Boston, MA, USA,
| | - Danson R. Jones
- Institutional Research, Wharton County Junior College, Wharton, TX 77488, USA,
| | - Charles F. Rodican
- Community Intervention Research, McLean Hospital, Belmont, MA 02478, USA,
| | - William H. Fisher
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA,
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Kearney CA, Bensaheb A. School absenteeism and school refusal behavior: a review and suggestions for school-based health professionals. THE JOURNAL OF SCHOOL HEALTH 2006; 76:3-7. [PMID: 16457678 DOI: 10.1111/j.1746-1561.2006.00060.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
School absenteeism and school refusal behavior are particularly difficult problems that school health professionals often face. Unfortunately, few recommendations are available to such professionals about how to address this population. In this article, we (1) outline the major characteristics of school absenteeism and school refusal behavior, (2) review school-based health programs that have been designed in part to reduce absenteeism, and (3) provide suggestions for school health professionals regarding individual youths with school refusal behavior.
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Macias C, Barreira P, Hargreaves W, Bickman L, Fisher W, Aronson E. Impact of referral source and study applicants' preference for randomly assigned service on research enrollment, service engagement, and evaluative outcomes. Am J Psychiatry 2005; 162:781-7. [PMID: 15800153 PMCID: PMC2759892 DOI: 10.1176/appi.ajp.162.4.781] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The inability to blind research participants to their experimental conditions is the Achilles' heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for research participants' preference for one experimental program over another to compromise the generalizability and validity of randomized controlled service evaluations as well as cross-study comparisons. METHOD Three Cox regression analyses measured the impact of applicants' service assignment preference on research project enrollment, engagement in assigned services, and a service-related outcome, competitive employment. RESULTS A stated service preference, referral by an agency with a low level of continuity in outpatient care, and willingness to switch from current services were significant positive predictors of research enrollment. Match to service assignment preference was a significant positive predictor of service engagement, and mismatch to assignment preference was a significant negative predictor of both service engagement and employment outcome. CONCLUSIONS Referral source type and service assignment preference should be routinely measured and statistically controlled for in all studies of mental health service effectiveness to provide a sound empirical base for evidence-based practice.
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Affiliation(s)
- Cathaleene Macias
- Community Intervention Research, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA.
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Affiliation(s)
- Golda S Ginsburg
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Baltimore, MD 21287-3325, USA
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Abstract
PURPOSE OF REVIEW Anxiety disorders constitute a significant problem among children and adolescents, with estimated prevalence of 6 to 10%. Left untreated, anxiety disorders can have major effect on academic, social, and family function, as well as impact on developmental progress. Effective treatment of childhood anxiety disorders with medications may help reduce morbidity and improve functioning and stress management. RECENT FINDINGS There are many reviews, but few studies, that examine the effect of psychotropic medication on anxiety disorders in children and adolescents. Most of our understanding comes from extrapolation from literature on adult medication trials. Available data indicate relative effectiveness of serotonin selective reuptake inhibitors in many childhood anxiety disorders, along with minimal side effects and good tolerability. Many other psychotropic medications have been considered and used to manage anxiety, with little data to support in children. SUMMARY The serotonin selective reuptake inhibitors are considered a first-line pharmacological treatment for anxiety disorders in children and adolescents. Numerous other psychotropic medications may be considered, alone or in combination. Definitive research is lacking; further research studies are sorely needed to help guide clinical decision making. Because there are few studies of pharmacologic treatment of anxiety in children and adolescents, this article will consider the most current literature and provide an overall summary of the topic.
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Affiliation(s)
- Thomas P Williams
- University of Rochester School of Medicine, Rochester, New York, USA
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Compton SN, Burns BJ, Helen LE, Robertson E. Review of the evidence base for treatment of childhood psychopathology: internalizing disorders. J Consult Clin Psychol 2002; 70:1240-66. [PMID: 12472300 DOI: 10.1037/0022-006x.70.6.1240] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reviews the empirical literature on psychosocial, psychopharmacological, and adjunctive treatments for children between the ages of 6 and 12 with internalizing disorders. The aim of this review was to identify interventions that have potential to prevent substance use disorders in adolescence by treating internalizing disorders in childhood. Results suggest that a variety of behavioral, cognitive-behavioral, and pharmacological interventions are effective in reducing symptoms of childhood depression, phobias, and anxiety disorders. None of the studies reviewed included substance abuse outcomes. Thus, little can be said about the relationship between early treatment and the prevention of later substance use. The importance of evaluating the generalizability of research-supported interventions to community settings is highlighted and recommendations for future research are offered.
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Affiliation(s)
- Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Durham, North Carolina 27705, USA.
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Abstract
Most empirically supported interventions for adolescent mental health problems are either downward adaptations of adult treatments or upward adaptations of child treatments. Although these treatments show respectable effects with teens, a review of the outcome research reveals significant gaps. both in coverage of adolescent conditions and problems (e.g., eating disorders, suicidality) and in attention to the biological, psychological, and social dimensions of adolescent development. The authors critique the field, propose a biopsychosocial framework for the development of dysfunction and intervention, and discuss ways the developmental literature can and cannot inform intervention and research. A long-term goal is an array of developmentally tailored treatments that are effective with clinically referred teens and an enriched understanding of when, how, and why the treatments work.
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Affiliation(s)
- John R Weisz
- Department of Psychology, University of California, Los Angeles 90095-1563, USA
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Brown RT, Sammons MT. Pediatric psychopharmacology: A review of new developments and recent research. ACTA ACUST UNITED AC 2002. [DOI: 10.1037/0735-7028.33.2.135] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE Psychiatric comorbidity is common in anxious children. The purpose of this study was to investigate the impact of comorbidity on treatment outcome in anxious children. METHOD Participants were 173 children between the ages of 8 and 13 years who met primary DSM-III-R/DSM-IV diagnoses of separation anxiety disorder, overanxious disorder/generalized anxiety disorder, or avoidant disorder/social phobia assessed by the Anxiety Disorders Interview Schedule for Children (ADIS-C). The majority (79%) had at least one comorbid diagnosis. Participants were randomly assigned to cognitive-behavioral therapy or waitlist. Group differences in ADIS-C diagnoses were compared after treatment. Multiple parent and child self-report measures were used to measure symptoms as well. RESULTS Pretreatment comorbidity was not associated with differences in treatment outcome: 68.4% of noncomorbid participants and 70.6% of comorbid participants were free of their primary diagnosis after treatment. Regarding parent and child self-report symptoms, multivariate analyses of variance revealed significant time (treatment) main effects, but no significant main effect for group (comorbid status) or time/group interaction. CONCLUSIONS The cognitive-behavioral treatment program was similarly effective in anxious children with and without comorbid disorders; both groups showed clinically significant reductions in pretreatment diagnoses and symptoms.
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Affiliation(s)
- P C Kendall
- Child and Adolescent Anxiety Disorders Clinic, Department of Psychology, Temple University, Philadelphia, PA 19122, USA
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Kashdan TB, Herbert JD. Social anxiety disorder in childhood and adolescence: current status and future directions. Clin Child Fam Psychol Rev 2001; 4:37-61. [PMID: 11388563 DOI: 10.1023/a:1009576610507] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of "positive psychology" constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.
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Affiliation(s)
- T B Kashdan
- Department of Psychology, State University of New York at Buffalo, 14260-4110, USA.
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Manassis K. Childhood anxiety disorders: lessons from the literature. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2000; 45:724-30. [PMID: 11086555 DOI: 10.1177/070674370004500805] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies of childhood anxiety disorders have increased in recent years, but the clinical implications of the work are sometimes difficult to discern. This paper reviews salient findings (related to the assessment and management of anxious children) published in the last 5 years. The high comorbidity among disorders, the occurrence of different disorders in the same child over time, recent changes in diagnostic categories, the availability of new anxiety measures, and poor correspondence between parent and child reports of symptoms all underscore the need for thorough assessment. Increasing evidence supports cognitive-behavioural treatments for anxiety disorders, alone or in combination with pharmacotherapy. Other important aspects of management suggested by developmental studies of anxious children include psychoeducation about constitutional factors in the development of anxiety, interventions to address parental anxiety, parenting advice regarding behaviour management and reduction of family conflict, and treatment of child impairment to decrease the risk of depression. Questions requiring further research are identified.
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Affiliation(s)
- K Manassis
- Anxiety Disorders Program, Hospital for Sick Children, Toronto, Ontario.
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Burns BJ, Hoagwood K, Mrazek PJ. Effective treatment for mental disorders in children and adolescents. Clin Child Fam Psychol Rev 1999; 2:199-254. [PMID: 11225935 DOI: 10.1023/a:1021826216025] [Citation(s) in RCA: 272] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.
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Affiliation(s)
- B J Burns
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Walsh J. Anti-anxiety medications: a review for social workers. SOCIAL WORK IN HEALTH CARE 1999; 30:31-49. [PMID: 10855801 DOI: 10.1300/j010v30n01_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Social workers in mental health settings frequently participate in the treatment of clients with incapacitating anxiety. Medication is often included among the interventions for these clients. Social workers, who specialize in psychosocial interventions, also have key roles in the assessment and monitoring of medication effects. The purpose of this article is to provide social workers with an overview of the pharmacological treatment of anxiety so that they can carry out their range of interventions more effectively. Included is information about types of medication and their dosages, positive and adverse effects, interactions of medication with other interventions, and special concerns with children and adolescents.
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Affiliation(s)
- J Walsh
- School of Social Work, Virginia Commonwealth University, Richmond 23284-2027, USA.
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