Intermixed safety cues facilitate extinction retention in adult and adolescent mice

Extinction learning is tremendously adaptive as it allows an animal to adjust their behavior in a changing environment. Yet, extinction is not without limitations and fear often reemerges over time (i.e. spontaneous recovery). Relative to adults, adolescent rodents and humans are particularly prone to spontaneous recovery following extinction. In this study, we aimed to address whether combining methods of fear regulation (extinction and conditioned inhibition) can facilitate extinction retention. Early adolescent (29 days old, n = 81) and adult (70 days old, n = 80) mice underwent extinction with or without a safety cue present. Safety cue presentations were systematically varied to overlap with or alternate with fear cue presentations. We found that initial safety learning was faster in adolescent mice. In addition, intermixing safety cues into extinction reduced spontaneous recovery during a test two weeks later. The decrease in spontaneous recovery relative to a standard extinction protocol was greater in adolescents than adults. Together, our findings provide initial evidence that safety learning may be inherently stronger during adolescence. These results inform the parameters by which conditioned safety and extinction learning may be merged to augment the inhibition of fear. While methods to enhance fear regulation are valuable for any age, the potential to do so during adolescence is particularly striking.

Predictors and Moderators of Parent Engagement in Early Interventions for Behaviorally Inhibited Preschool-Aged Children

Behavioral inhibition (BI) is a temperamental style that poses risk for later anxiety. Efficacious interventions have been developed for inhibited children, but their success depends on parent engagement. However, little is known regarding predictors of parent engagement in early interventions for BI. This study examined parent-, child- and treatment-level (i.e., parent-only or parent-child) factors as independent and interactive predictors of parent engagement (attendance, and parent-reported homework completion and treatment satisfaction) in a randomized-controlled trial comparing two interventions for inhibited preschoolers: Cool Little Kids (CLK) and the Turtle Program ("Turtle"). We also explored predictors of co-parent (CP) attendance. The sample comprised 151 primary parents (PPs) and their 45-64-month-old children. Attendance was greater in Turtle and homework completion was slightly greater in CLK, with no group difference in satisfaction. In Turtle, child anxiety predicted greater PP attendance and PP depression predicted lower satisfaction. In CLK, the interaction between child and PP anxiety significantly predicted satisfaction. Across groups, child anxiety predicted greater homework completion and CP anxiety predicted greater CP attendance. Results suggest that child anxiety may motivate parent engagement, particularly when children receive concurrent treatment and/or in-vivo coaching. However, intensive treatment may be too burdensome for depressed parents, whereas less intensive treatments may be more acceptable to non-anxious parents of anxious children. These findings can inform approaches to improve parent engagement in early interventions targeting BI.

Factors Associated With Parental Consent to use D-Cycloserine for Child Anxiety

This study examined factors influencing parent willingness to use D-Cycloserine (DCS) for treating child anxiety. N = 222 parents were given information about using DCS to treat anxiety. They were then asked to rate their willingness to allow their child to take DCS/antibiotics for mild anxiety, severe anxiety, or an infection. The associations between willingness to use DCS and parental trait anxiety, demographics, as well as specific concerns regarding the medication, were examined. Parents could also provide written responses regarding their attitudes to DCS, which were analysed for themes. Parents reported concerns regarding potential side-effects from DCS. More severe anxiety was associated with more willingness to consent; however, parents were more willing to use antibiotics to treat an infection than DCS to treat their child's anxiety. The degree of perceived benefit from DCS was most strongly associated with parents’ willingness to use it. Overall, parents expressed mixed views, reporting they would consider using DCS to treat their child; however, they had significant concerns about it. Results suggest providing parents with information explaining how DCS works, its risks and potential benefits may increase its acceptability.

Effects of Functional Analysis Information on Ratings of Intervention Effectiveness and Acceptability

Variables affecting ratings of intervention acceptability and effectiveness have been widely studied. In the literature, several variables have produced reliable results, such as type of intervention and severity of problem behavior. One variable that remains uninvestigated is the effect of providing functional analysis information on ratings of interventions. We analyzed the ratings of 55 teachers for both the effectiveness and acceptability of a range of interventions. We also evaluated the impact on those ratings of providing three levels of functional information about the targeted problem behavior: (a) structural (descriptive) information, (b) information describing an escape function (negative reinforcement), and (c) information describing an attention function (positive reinforcement). Sample demographics are reported, along with scores on an evaluation of knowledge of behavioral principles and causes of problem behavior. The teachers differentially rated brief interruption and differential reinforcement according to the functional information provided in the case vignettes. Severity of the problem behavior did not influence ratings. The implications of the findings are discussed in terms of teacher training and support for intervention efforts that include functional assessment strategies.

Parents' Perceptions of Novel Treatments for Child and Adolescent Specific Phobia and Anxiety Disorders

This study aimed to examine parents' perceptions of established treatments, including cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), relative to novel treatments of D-cycloserine (DCS) and attention bias modification (ABM) augmented CBT to determine if novel treatments are perceived as more or less favorable than established treatments. Participants included parents of children with a specific phobia, enrolled in one of two randomized controlled trials of either one-session augmented DCS (n = 38, Gold Coast) or ABM augmented one-session treatment (n = 34, Brisbane), as well as parents from a community sample (n = 38). Parents of children with a specific phobia perceived CBT most favorably. There was no difference between the sites on perceptions of ABM. However, parents of children enrolled in the DCS trial perceived DCS more favorably than parents of children enrolled in the ABM trial and the community sample. These results demonstrate parents' greater acceptance of psychological treatments over pharmacological treatments for the treatment of childhood phobias, highlighting the importance of educating parents to novel treatments.

Child impairment and parenting self-efficacy in relation to mothers' views of ADHD treatments

OBJECTIVE

This study assessed the relations of child impairment and parenting self-efficacy with parental views of the acceptability and effectiveness of behavioral, medication, and combined treatments for child ADHD. Child impairment and parenting self-efficacy were also assessed in relation to the effectiveness views of specific behavioral treatment strategies.

METHOD

Ninety-five mothers of children with ADHD completed questionnaires assessing child impairment, parenting self-efficacy, perceptions of the overall acceptability and effectiveness of ADHD treatments, and views of the effectiveness of specific behavioral treatment strategies.

RESULTS

Hierarchical linear modeling using child impairment and parenting self-efficacy as predictors of treatment views suggests that mothers viewed combined treatments as most acceptable and effective when their child was more impaired, and mothers with higher parenting self-efficacy rated behavioral treatment strategies as more effective.

CONCLUSION

Child impairment and parenting self-efficacy are related to perceptions of the acceptability and/or effectiveness of ADHD treatments.

Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder

A number of evidence-based treatments are available for attention-deficit/hyperactivity disorder (ADHD), including pharmacological, psychosocial, or a combination of the two treatments. For a significant number of children diagnosed with ADHD, however, these treatments are not utilized or adhered to for the recommended time period. Given that adherence to treatment regimens is necessary for reducing the symptoms of ADHD, it is crucial to develop a comprehensive understanding of why adherence rates are so low. The current review examines the literature to date that has directly explored utilization and adherence issues related to the treatment of ADHD in order to identify the key barriers to treatment. This review focused on four main factors that could account for the poor rates of treatment utilization and adherence: personal characteristics (socio-demographic characteristics and diagnostic issues), structural barriers, barriers related to the perception of ADHD, and barriers related to perceptions of treatment for ADHD. This review included 63 papers and covered a variety of barriers to treatment that have been found in research to have an impact on treatment adherence. Based on this review, we conclude that there are complex and interactive relationships among a variety of factors that influence treatment utilization and adherence. Four main gaps in the literature were identified: (1) there is limited information about barriers to psychosocial interventions, compared to pharmacological interventions; (2) there is a limited variety of research methodology being utilized; (3) treatment barrier knowledge is mostly from parents' perspectives; and (4) treatment utilization and treatment adherence are often studied jointly. Information from this review can help practitioners to identify potential barriers to their clients being adherent to treatment recommendations.

The role of stigma in parental help-seeking for child behavior problems

The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems.

The Social Validity of Interventions for Promoting Preschool Children's Peer Interactions

This analogue study investigated the social validity of classroom interventions designed to promote peer interactions in young children. The influences of child characteristics and diagnostic labels on social validity ratings were examined, as were the relationships among three components of social validity. Forty-two preschool teachers completed a 15-item social validity scale that yielded scores pertaining to intervention goals, procedures and effects. Participants rated three types of intervention, which varied according to individuals targeted and intensity of programming procedures, with reference to one of three case descriptions of children with social interaction problems. Half the participants were provided with the child's diagnostic label. Results indicated that social validity is affected by interactions between intervention methods and child characteristics. The inclusion of diagnostic labels in the case descriptions had no effect on social validity ratings. Strong positive relationships were found among the components of social validity. Implications for the use of empirically validated interventions in inclusive preschools are discussed.

Acceptability of behavioral and pharmacological treatments for attention-deficit/hyperactivity disorder: relations to child and parent characteristics

One-hundred nine mothers of 5- to 12-year-old boys with attention-deficit/hyperactivity disorder (ADHD) participated. Mothers read case descriptions of boys with ADHD and of boys with both ADHD and oppositional defiant disorder (ODD). Half of the mothers were randomly assigned to read descriptions of behavioral parent training and half to read descriptions of stimulant medication as treatments for the children in the case descriptions. Mothers rated the acceptability and effectiveness of the treatments and provided information on their experiences with both types of treatment. Mothers rated behavioral parent training as more acceptable than medication. There was no difference in ratings of the effectiveness of the two treatments in the scenarios, and mothers rated medication as more effective than behavioral strategies with their own children. Comorbidity of ADHD and ODD did not influence ratings of acceptability or effectiveness. Mothers' ratings of the acceptability of behavioral parent training were related to how much they believed in these strategies and how effective the strategies were with their own children. Although mothers' ratings of the acceptability of medication were related to their beliefs in this form of treatment, they were not related to perceptions of effectiveness of medication for their own child. Implications for understanding the difficulties faced by parents of children with ADHD in treatment decision-making are presented.

Predictors of attitudes towards treatments for bulimia nervosa

OBJECTIVE

The aim of this study was to examine, using Mental Health Literacy, acceptability and correlates of acceptability of three treatment interventions for bulimia nervosa; medication, psychological therapy and self-change/lifestyle therapies.

METHOD

A self-report questionnaire to ascertain correlates of attitudes towards the three interventions was used. Respondents (n = 177) were females aged 18-53 years.

RESULTS

Psychological therapy was rated the most acceptable treatment to participants as well as the most acceptable to others, and to have most advantages and fewest disadvantages, followed by self-change/lifestyle therapies, and then medication. Social Pressures to be Thin was the most strongly endorsed cause of bulimia, followed by Low Self-Esteem, Eating Behaviour, Relationship and Family Environment, and lastly, Biology. Correlates with acceptability of different treatment approaches were identified.

CONCLUSIONS

Although no causal link can be assumed from this design, findings suggest that women appear to have a mixed understanding of the different mechanisms that each treatment intervention adopts to treat the causes and symptoms of bulimia, particularly self-change/lifestyle therapies. This may help to explain poor adherence to interventions.

The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50% of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents' ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered.

Parenting stress in mothers of children with an intellectual disability: the effects of parental cognitions in relation to child characteristics and family support

BACKGROUND

Recent theories of stress and coping in parents of children with intellectual disabilities (ID) emphasize the importance of cognitive appraisals in influencing parents' levels of stress and their adaptations to difficulties presented by the children. This study investigated the relationships between parental cognitions, child characteristics, family support and parenting stress. The aspects of cognitions studied were: parenting self-esteem (including efficacy and satisfaction) and parental locus of control.

METHODS

The group studied consisted of 46 mothers of children with ID. The Vineland Adaptive Behavior Scales and Maladaptive Behavior Domain were administered by interview. Mothers also completed four questionnaires: the Family Support Scale, the Parenting Sense of Competence Scale, a shortened form of the Parental Locus of Control Scale and the Parenting Stress Index (Short Form).

RESULTS

Data were analysed using Pearson's correlation coefficients, partial correlations and a regression analysis. The results indicated that most of the variance in parenting stress was explained by parental locus of control, parenting satisfaction and child behaviour difficulties. Whilst there was also a strong correlation between family support and parenting stress, this was mediated by parental locus of control.

CONCLUSIONS

The results demonstrate the potential importance of parental cognitions in influencing parental stress levels. It is argued that these results have implications for clinical interventions for promoting parents' coping strategies in managing children with ID and behavioural difficulties.

Behavioral function effects on intervention acceptability and effectiveness for self-injurious behavior

A variety of variables have been found to augment perceived social validity of behavioral interventions. In the present study, potential effects of behavioral function were evaluated. Sixty students inexperienced in work with people with mental retardation, and 60 experienced staff watched one of two carefully matched acted videos depicting self-injury maintained by attention or escape from task demands. Participants were also told whether the self-injury depicted typically led to mild or severe consequences for the person filmed. Participants rated six interventions in terms of their acceptability and effectiveness for the behavior depicted. A hierarchy of acceptability was replicated: reinforcement-based procedures were rated as more acceptable and effective. There were also effects of behavior severity and rater experience. However, few effects of behavioral function were found. Potential implications of staff undifferentiated attitudes towards functional treatments are discussed.

Parental opinions regarding treatment for social anxiety disorder in youth

This study surveyed parents' opinions about treatment for childhood social anxiety disorder and assessed variables that may affect treatment acceptability. A 20-item survey assessing treatment attitudes and a semistructured interview were administered to 190 parents of children (8-17 years) who were randomly selected from a pediatric primary care setting. An exploratory factor analysis of the treatment attitudes survey yielded four factors: medication acceptability, counseling acceptability, counseling feasibility, and general beliefs about social anxiety treatment. Findings revealed that parents endorsed favorable attitudes toward counseling and somewhat neutral beliefs about medication. White parents were more accepting of medication and counseling and also perceived counseling as more feasible than nonwhite parents. Treatment acceptance was associated with past mental health utilization but not with severity of social anxiety. Further research is necessary to determine if clinical interventions for child anxiety disorders may be more efficacious if parents' attitudes and beliefs about prescribed treatments are addressed.

Self-administered psychosocial treatments for children and families

Self-administered psychosocial treatments for child health problems have the potential to circumvent barriers to traditional models of care. They are convenient and inexpensive to families and, for some types of problems, may be as effective as therapist-based care. In a review of past research on child- and parent-facilitated self-administered treatments, it was found that a stronger evidence base exists in support of some formats (manual- and multimedia-based treatments) than for others (inspirational literature and support groups). The practical, ethical, and legal issues associated with self-administered treatments are discussed as well as avenues for future research. How psychologists and health care systems respond to the opportunities associated with self-administered treatments for children will likely affect the face of the profession and the health of children in the future.

Acceptability of treatments for trichotillomania. Effects of age and severity

Based on the literature, trichotillomania (TTM, chronic hair pulling) in children and adults appears to be responsive to behavioral interventions such as habit reversal. However, some have questioned the generality and acceptability of such procedures. This study compared the acceptability ratings of four interventions targeting TTM (habit reversal, hypnosis, medication, and punishment). In the study, 233 college students read case vignettes in which the age of the analogue client and the severity of the hair pulling were manipulated. Results showed significant differences between the four treatment conditions, with hypnosis and habit reversal being rated most acceptable. Age of the analogue client and severity of TTM did not significantly influence acceptability ratings.

Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate

OBJECTIVE

To determine the behavioral, situational, and temporal effects of 4 months of methylphenidate (MPH) treatment for attention-deficit hyperactivity disorder (ADHD).

METHOD

Ninety-one children with ADHD were randomly assigned to receive either MPH (titrated to a target dose of 0.7 mg/kg twice a day) or a placebo. Treatment effects were investigated with measures sensitive to various behaviors (core and associated symptoms), situations (home and school), time periods (morning and afternoon, after reaching the target dose, and after 4 months of treatment), and side effects.

RESULTS

MPH treatment improved symptoms of ADHD and oppositional behavior at school, both in the morning and afternoon, but not at home. Side effects (increase in physiological and effective symptoms, lack of weight gain) were significantly more frequent with MPH than with placebo treatment. Benefit was evident after titration, but the onset of some side effects was delayed. Side effects were reported by parents but not by teachers.

CONCLUSIONS

Positive effects of MPH on behavior are evident in the classroom, but with MPH given twice daily, parents do not report that MPH improves behavior at home. Greater impact on home behavior may require three times daily MPH and combined treatments.

Parents' perceptions of their child's emotional illness and psychiatric treatment needs

PROBLEM

The purpose of this study was to describe how parents define their child's emotional illness and psychiatric treatment needs.

SUBJECTS

The sample consisted of 19 parents and one grandparent (N = 20) who had recently admitted their child to a short-term psychiatric unit.

METHODS

Qualitative methods, utilizing a semistructured interview. Data were analyzed using the constant comparative method. Substantive codes were combined to derive the key concepts and themes in the interviews.

FINDINGS

The findings of this study center on themes related to parents' efforts to control the current behavioral crisis, treatment acceptability, family needs, explanatory formulations, and securing the child's future.

CONCLUSIONS

Implications for treatment include how nurses might tap into parents' perceptions to facilitate parent' professional communication.

Dropping out of marriage and family therapy: a critical review of research

The lack of attention given to research on the premature termination by clients in marriage and family therapy is evident in research reviews of the dropout phenomenon in psychotherapy. This article is an attempt to fill that void. The research literature on dropping out of family therapy is reviewed and organized. Studies in this area tend to focus on four kinds of variables: client characteristics, therapist characteristics, therapy process variables, and interventions. Stable findings in each of these areas are pointed out. Both limitations and recommendations for future research are discussed.

Assessing treatment acceptance: the Abbreviated Acceptability Rating Profile

As part of a broad focus on service accountability, increased attention has been devoted to the assessment of consumer judgments of treatment acceptability. Current treatment acceptability measures are limited by item complexity and time-intensiveness. These limitations were addressed with the modification of an existing instrument (Intervention Rating Profile; Witt & Elliott, Journal of Abnormal Child Psychology, 13, 59-67, 1985). Psychometric support was found for the revised measure (Abbreviated Acceptability Rating Profile; AARP) in an initial sample of parents (N = 60) who rated child treatments. Results were replicated in a cross-validation study of a second independent sample of parents (N = 80). A third sample of subjects was used to assess the time-intensiveness and readability of the AARP. The usefulness of the modified instrument is discussed.

Acceptability of interventions for childhood depression

Using a case description methodology, this study examined the effects of behavior problem severity, intervention type, and subject race on mothers' acceptability ratings of five interventions used to treat childhood depression. Results indicated that (a) all psychological (behavioral or cognitive-behavioral) interventions were rated more acceptable than pharmacological treatment; (b) among the psychological interventions, the social skills intervention was the least preferred; (c) acceptability of treatments varied as a function of subject race; and (d) severity of depressive symptoms failed to influence acceptability ratings significantly. Psychometric support was found for a revised measure of acceptability (Abbreviated Acceptability Rating Profile; AARP) developed in the context of the present study. Implications of the findings for consultation are discussed.

Is social validity what we are interested in? Argument for a functional approach

It is argued that neither the term social nor the term validity is best to identify the processes used or the results obtained in questioning consumers about the goals set, procedures employed, or outcomes achieved in habilitative programming. The term consumer satisfaction acknowledges the fact that it is essentially a collection of consumer opinions. The underlying intent of the process might be called habilitative validation, a name that seems to better guide our validation efforts. More important, in carefully considering consumer satisfaction assessment, it becomes clear that not only does consumer satisfaction itself need to be validated, but also that more objective methods can be used for assessing habilitative validity. However, legitimate uses still remain for consumer satisfaction measurement, as long as we do not mistake it for strong evidence of the habilitative validity of our goals, procedures, or outcomes.