Analysis of variance frameworks in clinical child and adolescent psychology: advanced issues and recommendations

Caution When Screening for Autism among Socially Anxious Youth

Social anxiety disorder (SAD) is commonly comorbid with autism spectrum disorder (ASD). Here, in a sample of 86 children and adolescents (MAGE = 12.62 years; 68.6% male), 28 of whom were diagnosed with ASD, 34 with SAD, and 24 with comorbid ASD and SAD, we compared parent-reported scores from the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber in Social Responsiveness Scale (SRS; Constantino and Gruber 2012) to determine the sensitivity and specificity of the measure in cases of differential diagnosis between SAD and ASD. Results suggest that neither the subscales, nor the SRS-2 total score, consistently differed between ASD and SAD. Sensitivity and specificity analyses suggested that the SRS-2 total poorly discriminated ASD from SAD. When screening socially anxious youth for possible ASD, caution should be taken.

Impulsivity as a mechanism linking child abuse and neglect with substance use in adolescence and adulthood

Emerging developmental perspectives suggest that adverse rearing environments promote neurocognitive adaptations that heighten impulsivity and increase vulnerability to risky behavior. Although studies document links between harsh rearing environments and impulsive behavior on substance use, the developmental hypothesis that impulsivity acts as mechanism linking adverse rearing environments to downstream substance use remains to be investigated. The present study investigated the role of impulsivity in linking child abuse and neglect with adult substance use using data from (a) a longitudinal sample of youth (Study 1, N = 9,421) and (b) a cross-sectional sample of adults (Study 2, N = 1,011). In Study 1, the links between child abuse and neglect and young adult smoking and marijuana use were mediated by increases in adolescent impulsivity. In Study 2, indirect links between child abuse and neglect and substance use were evidenced via delayed reward discounting and impulsivity traits. Among impulsivity subcomponents, robust indirect effects connecting childhood experiences to cigarette use emerged for negative urgency. Negative urgency, positive urgency, and sensation seeking mediated the effect of child abuse and neglect on cannabis and alcohol use. Results suggest that child abuse and neglect increases risk for substance use in part, due to effects on impulsivity. Individuals with adverse childhood experiences may benefit from substance use preventive intervention programs that target impulsive behaviors.

Is Trauma Memory Special? Trauma Narrative Fragmentation in PTSD: Effects of Treatment and Response

Seminal theories posit that fragmented trauma memories are critical to posttraumatic stress disorder (PTSD; van der Kolk & Fisler, 1995; Brewin, 2014) and that elaboration of the trauma narrative is necessary for recovery (e.g., Foa, Huppert, & Cahill, 2006). According to fragmentation theories, trauma narrative changes, particularly for those receiving trauma-focused treatment, should accompany symptom reduction. Trauma and control narratives in 77 men and women with chronic PTSD were examined pre- and post-treatment, comparing prolonged exposure (PE) and sertraline. Utilizing self-report, rater coding, and objective coding of narrative content, fragmentation was compared across narrative types (trauma, negative, positive) by treatment modality and response, controlling for potential confounds. Although sensory components increased with PE (d = 0.23 - 0.44), there were no consistent differences in fragmentation from pre- to post-treatment between PE and sertraline or treatment responders and non-responders. Contrary to theories, changes in fragmentation may not be a crucial mechanism underlying PTSD therapeutic recovery.

Maternal expectancy versus objective measures of child skill: evidence for absence of positive bias in mothers' expectations of children with internalizing disorders

Parents of anxious children are thought to be more attuned to threat, which might translate into less positive bias in parental report of child coping and ability, unlike parents of non-anxious children. Maternal expectancy bias was examined in a sample of 43 clinically anxious (51 % female), 30 clinically anxious/depressed (50 % female), and 44 non-clinical control children (46 % female), 8-14 years of age. When compared to an objective observer's ratings of the children, mothers of non-clinical children demonstrated a positive bias (i.e., over-rated their children's performance) for both ratings of expected speech performance in absolute terms and relative to peers. Mothers in the clinical groups did not exhibit this positive expectancy bias. Moreover, mothers of clinical children reported lower expectations in absolute terms and relative to peers than mothers of non-clinical children. The data suggest that mothers of clinical children held accurate expectations for child performance when compared to the gold standard of an objective observer.

Reductions in anxiety and depression symptoms in youth receiving substance use treatment

BACKGROUND AND OBJECTIVES

Research shows that interventions for substance use disorders may be helpful in reducing internalizing disorders in adolescents. This paper examines the prevalence and reductions of anxiety and depression symptoms among youth receiving substance use treatment.

METHODS

Four hundred eighty adolescents ages 12-17 who received treatment for substance abuse as part of the Brief Strategic Family Therapy effectiveness trial were screened for anxiety and depression using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS). Twelve-month post-randomization assessments were completed by 327 parents and 315 youth. Sixty-five percent of the sample was found to have probability of at least one anxiety disorder or depression diagnosis.

RESULTS

Significant reduction of anxiety and depressive symptoms and significant reductions in probable anxiety and depression diagnoses were observed at follow-up. Few differences by treatment type and by ethnic group were noticed.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Findings indicate that substance use interventions might help reduce the prevalence of anxiety and depressive symptoms and the probability of these disorders.

Anxious youth in research and service clinics

With the current focus on increasing utilization of empirically supported treatments, knowledge of sample differences and similarities has increasing importance. The present study compared anxiety-disordered youth (age 7-13) from (a) five Norwegian service clinics (SC, N = 111) to (b) a university research clinic (RC) in Philadelphia, USA (N = 144) on pre-treatment characteristics measured by the Multidimensional Anxiety Scale for Children, Child Behavior Checklist, Teacher Report Form, Anxiety Disorders Interview Schedule, and Children's Global Assessment Scale (CGAS). SC youth demonstrated higher levels of anxiety based on child- (d = 0.42-1.04) and parent-report (d = 0.53) and conduct problems based on parent-report (d = 0.43) compared to RC youth. SC youth was more functionally impaired on the CGAS (d = 0.97), whereas RC youth evidenced a greater number of diagnoses (d = 0.63). The two samples were equivalent regarding parent-reported symptoms of affective, somatic, attention-deficit/hyperactivity, and oppositional problems. Future directions and clinical implications are discussed.

Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.

Characteristics of anxious and depressed youth seen in two different clinical contexts

Previous research has revealed that youth seen at community clinics present with a higher frequency of externalizing problems and are demographically different from youth seen at research clinics. This study extends findings on these discrepancies by examining differences between youth at research and community clinics meeting criteria for two different primary disorders (anxiety and depression). Consistent with prior research, community clinic youth reported lower incomes, were more ethnically diverse, and had higher rates of externalizing problems compared to research clinic youth, regardless of primary diagnosis. Findings are discussed in terms of enhancing dissemination of evidence-based treatments for internalizing disorders in community settings.

Examination of posttraining supervision of peer counselors in a motivational enhancement intervention to reduce drinking in a sample of heavy-drinking college students

Importance of peer counselor posttraining supervision on motivational interviewing (MI) microskills and postintervention drinking outcomes were evaluated in a sample of heavy-drinking undergraduate students completing Brief Alcohol Screening and Intervention for College Students (BASICS; L.A. Dimeff, J.S. Baer, D.R. Kivlahan, & G.A. Marlatt, 1999). Two peer counselor groups were trained using identical protocols. Posttraining, one group was randomized to receive supervision, whereas the other received no supervision. Groups were subsequently compared on MI microskills. College students (n = 122) were randomly assigned to either assessment-only control, supervision, or no supervision groups and completed a BASICS intervention. Postintervention drinking outcomes were examined. Results suggested supervision aided peer counselors in reducing use of closed-ended questions. Both treatment groups reduced total drinks per week and heavy-drinking behaviors compared to control. No differences on peak blood alcohol concentration (BAC) or alcohol-related consequences were observed. Differences in supervision did not influence drinking outcomes; however, posttraining supervision for peer counselors deficient in MI microskills may be needed to improve BASICS fidelity.

Pre-sleep arousal and sleep problems of anxiety-disordered youth

The current study examined sleep problems and pre-sleep arousal among 52 anxious children and adolescents, aged 7-14 years, in relation to age, sex, ethnicity, and primary anxiety disorder. Assessment included structured diagnostic interviews and parent and child completed measures of sleep problems and pre-sleep arousal. Overall, 85% of parents reported clinically-significant child sleep problems, whereas 54% of youth reported trouble sleeping. Young children, those with primary generalized anxiety disorder, and Latino youth experienced the greatest levels of sleep disturbance. Additionally, greater levels of pre-sleep cognitive rather than somatic arousal were found and pre-sleep thoughts were associated with decreased total sleep duration and greater sleep problems. Findings suggest that attention to sleep should be part of assessment procedures for anxious children in both research and clinical settings.

A preliminary investigation of sudden gains in exposure therapy for PTSD

The purpose of the current study was to examine sudden gains in those receiving treatment for PTSD and whether these rapid changes were related to overall symptom reduction in a small sample of female assault survivors with PTSD undergoing prolonged exposure (PE) therapy. Sudden gains were found to occur in 52% of the sample. Among those who experienced a sudden gain, the average magnitude (12.4 points) accounted for 61% of overall symptom reduction. Importantly, treatment outcome was better for those who experienced sudden gains than those who did not. The experience of a sudden gain may result in patients becoming more fully engaged with treatment, and recognition of them may result in identifying potential process-related predictors of treatment response.

The Picture Anxiety Test (PAT): a new pictorial assessment of anxiety symptoms in young children

This study examines the psychometric properties of a newly developed pictorial anxiety assessment, the Picture Anxiety Test (PAT), designed for young children. A sample of 71 5-7-year-old children (clinically anxious and healthy controls) participated in an assessment comparing the PAT to other, established anxiety measures. Children's ratings were also compared to parent ratings of internalizing and externalizing problems. The PAT demonstrated favorable psychometric properties in this sample, including moderate to high internal consistency, high convergent validity with related constructs, and high discriminant validity between diagnostic groups and across pre- and post-treatment. Initial findings suggest that the PAT is a psychometrically sound instrument for assessing child anxiety and avoidance in young children and a valuable addition to existing diagnostic instruments for clinicians working with anxious children.

Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents

BACKGROUND

Existing research indicates sleep problems to be prevalent in youth with internalizing disorders. However, childhood sleep problems are common in the general population and few data are available examining unique relationships between sleep, specific types of anxiety and depressive symptoms among non-clinical samples of children and adolescents.

METHODS

The presence of sleep problems was examined among a community sample of children and adolescents (N=175) in association with anxiety and depressive symptoms, age, and gender. Based on emerging findings from the adult literature we also examined associations between cognitive biases and sleep problems.

RESULTS

Overall findings revealed significant associations between sleep problems and both anxiety and depressive symptoms, though results varied by age. Depressive symptoms showed a greater association with sleep problems among adolescents, while anxiety symptoms were generally associated with sleep problems in all youth. Cognitive factors (cognitive errors and control beliefs) linked with anxiety and depression also were associated with sleep problems among adolescents, though these correlations were no longer significant after controlling for internalizing symptoms.

CONCLUSIONS

Results are discussed in terms of their implications for research and treatment of sleep and internalizing disorders in youth.

Parent-child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: a pilot efficacy study

This study evaluates the initial efficacy of the Parent-Child Interaction Therapy (PCIT) for Puerto Rican preschool children aged 4-6 years with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), combined or predominantly hyperactive type, and significant behavior problems. Thirty-two families were randomly assigned to PCIT (n = 20) or a 3.5-month waiting-list condition (WL; n = 12). Participants from both groups completed pretreatment and posttreatment assessments. Outcome measures included child's ADHD symptoms and behavior problems, parent or family functioning, and parents' satisfaction with treatment. ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes, except mother's depression, and in the expected direction (p < .01). Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors, conduct problems assessed as problematic, parenting stress associated with their child's behavior, and an increase in the use of adequate parenting practices. For the WL group, there were no clinically significant changes in any measure. Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment. PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems.

Directionality of change in youth anxiety treatment involving parents: an initial examination

This randomized clinical trial compared cognitive behavioral therapy (CBT) with minimal parent involvement to CBT with active parent involvement in a sample of 119 youths (7-16 years old; 33.6% Caucasian, 61.3% Latino) with anxiety disorders. The dynamics of change between youth anxiety and parent variables (positive-negative behaviors toward the child, conflict in the parent-youth relationship, and parental anxiety) in both treatment conditions over pretreatment, posttreatment, and 12-month follow-up were also examined. Results indicated that youth anxiety was significantly reduced with both treatments and that the dynamics of change may not solely flow from parent to youth but also from youth to parent. Findings highlight the need for research on directionality and mechanisms of change to move from evidence-based treatments toward evidence-based explanations of treatment outcome.

What would you choose? Sertraline or prolonged exposure in community and PTSD treatment seeking women

BACKGROUND

Both sertraline (SER) and prolonged exposure (PE) are empirically supported treatments for chronic posttraumatic stress disorder (PTSD). While efficacious, these treatments are quite different in approach, and such differences may influence both treatment choice and treatment outcome. To date, we know very little about the relative efficacy of pharmacological and psychological treatments for chronic PTSD.

METHOD

In Study 1, we compared rates of treatment choice (SER or PE) in 74 trauma-exposed women. In Study 2, we extended this work to an open-choice treatment trial, in which 31 female assault survivors with chronic PTSD received their choice of SER or PE for ten weeks and were followed over time.

RESULTS

In Study 1 (82%) and Study 2 (74.2%), the majority of women chose PE. In Study 2, both SER and PE evidenced moderate to large unadjusted effect sizes, with evidence of an advantage for PE in propensity adjusted analyses at posttreatment. Women with co-occurring major depressive disorder (MDD) were more likely to choose SER than those without MDD. However, among those with MDD, the advantage of PE was particularly evident.

CONCLUSIONS

Our results highlight the presence of clear treatment preferences for PTSD and their potential impact on outcome. This study underscores the importance of systematic study of patient preferences and encourages a rethinking of one-size fits all approaches to treatment for mental disorders.

Putting research in context: understanding confidence intervals from one or more studies

OBJECTIVES

To support wider use and higher quality interpretation of confidence intervals (CIs) in psychology.

METHODS

We discuss the meaning and interpretation of CIs in single studies, and illustrate the value of CIs when reviewing and integrating research findings across studies. We demonstrate how to find CIs from summary statistics and published data in some simple situations.

RESULTS

We provide the ESCI graphical software, which runs under Microsoft Excel, to assist with calculating and plotting CIs. (www.latrobe.edu.au/psy/esci)

CONCLUSIONS

The wider use of CIs in psychology should support quality research communication and integrated interpretation of findings in context.

Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents

The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.

Alcohol involvement and participation in residential learning communities among first-year college students

OBJECTIVE

Residential learning communities (RLCs) on U.S. college campuses are assumed to build connections between formal learning opportunities and students' living environment. The objective of this longitudinal study was to examine the association between living in RLCs and alcohol misuse among first-year undergraduate students.

METHOD

A Web-based survey was self-administered to a stratified random sample of 923 first-year undergraduate students (52.7% women) attending a large Midwestern research university. The sample included 342 students who lived and participated in RLCs (termed RLC) and 581 students who did not participate in RLCs (termed non-RLC). First-year students were asked about their drinking behaviors before college, during their first semester, and approximately 6 months later during their second semester.

RESULTS

RLC students reported lower rates of drinking than non-RLC students before college. RLC students reported lower rates of drinking and fewer alcohol-related consequences than non-RLC students during the first and second semesters. Maximum drinks in 1 day increased from precollege to first semester, and this increase was larger among non-RLC students than RLC students. The number of drinks per occasion and alcohol-related consequences increased between first semester and second semester for all students regardless of RLC status.

CONCLUSIONS

Lower rates of alcohol misuse among RLC students predate their entrance into college, and the increase in drinking from precollege to first semester is lower in magnitude among RLC students. RLCs' influence involves selection and socialization processes. These findings have implications for prevention and intervention efforts aimed at incoming first-year undergraduate students.

Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect?

The current study evaluated whether difficulties regulating emotions explained unique variance in binge eating and examined which types of emotion regulation difficulties are most strongly associated with binge eating. The Eating Disorders Diagnostic Scale and the Difficulties in Emotion Regulation Scale were completed by 695 undergraduates. Hierarchical regression results indicated that difficulties regulating emotions accounted for a significant amount of the variance in binge eating over and above sex, food restriction, and over-evaluation of weight and shape. Results also indicated that greater difficulty identifying and making sense of emotional states, and limited access to emotion regulation strategies were primarily responsible for the link between emotion regulation difficulties and binge eating. This supports a model of binge eating that includes emotional vulnerability and a deficit of skills to functionally modulate negative moods.

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear-based mechanisms play an important role in attentional biases for pain-related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear-based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between-group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.

Client Similarities and Differences in Two Childhood Anxiety Disorders Research Clinics

Some evidence suggests that research and service clinics differ on treatment-relevant dimensions, but no study has examined whether research clinics (RCs) themselves differ. We compared 2 samples of children and adolescents (ages 7 to 17 years) with anxiety disorders treated in 2 different university-based child anxiety RCs, one in Philadelphia (n = 184) and one in Miami (n = 64), on child symptom and diagnostic measures, family characteristics (e.g., income), and level of maternal depression. The samples were not significantly different on any youth symptom and diagnostic measures except 1 (parent-reported diagnoses); further, the 2 samples were statistically equivalent on 3 of 6 youth symptom measures. Although the Miami sample had significantly more parent-reported diagnoses than the Philadelphia sample, the effect size was small (Cohen's d = .44). Statistically significant differences between the samples in ethnic background and family income were observed, though the former was not significant after controlling for population differences. Findings are discussed in terms of the implications of homogeneity of RCs for treatments tested there.

Race and Ethnic Differences and Human Figure Drawings: Clinical Utility of the DAP:SPED

This study examined race and ethnic differences on the Draw A Person: Screening Procedure for Emotional Disturbance (DAP:SPED; Naglieri, McNeish, & Bardos, 1991) for youths 6 though 17 years of age for 2 matched samples. Samples were drawn from the DAP:SPED nationally representative standardization sample and matched on gender, grade, and school classroom. No statistically significant differences were found for big figure, small figure, or shading item composites. A statistically significant difference was found between Black-White pairs on figure omissions but showed a small effect size (d value = .25). Further, no statistically significant differences were found between the DAP:SPED Total T scores for Black and White youth (M = 47.67, SD = 10.09; N =138) or Hispanic and White youth (M = 48.20, SD = 9.56; N = 59), showing very small effect sizes. In addition, equivalence testing showed similarities across race and ethnic pairs for all composites and DAP:SPED total score, lending preliminary support to the DAP:SPED's clinical utility as a measure that yields similar scores across these groups.

Pairwise multiple comparison test procedures: an update for clinical child and adolescent psychologists

Locating pairwise differences among treatment groups is a common practice of applied researchers. Articles published in this journal have addressed the issue of statistical inference within the context of an analysis of variance (ANOVA) framework, describing procedures for comparing means, among other issues. In particular, 1 article (Jaccard & Guilamo-Ramos, 2002b) presented some new methods of performing contrasts of means whereas another presented a framework for obtaining robust tests within this same context (Jaccard & Guilamo-Ramos, 2002a). The purpose of this article is to add to these contributions by presenting some newer methods for conducting pairwise comparisons of means, that is by extending the contributions of the first article and applying the framework of the second article to pairwise multiple comparisons. The newer methods are intended to provide additional sensitivity to detect treatment group differences and provide tests that are robust to the effects of variance heterogeneity, nonnormality, or both.

Longitudinal outcomes of very low birth weight: neuropsychological findings

To investigate the effects of very low birth weight (VLBW, &1500 g) on the development of neuropsychological skills, we assessed 67 children with birth weight <750 g, 64 with birth weight 750-1499 g, and 67 term-born controls. Growth modeling of raw scores from mean ages 7-14 years revealed persistent VLBW sequelae. Even when adjusting for IQ, the <750 g group scored more poorly than the term-born group on measures of language processing, verbal list learning, and perceptual-motor and organizational abilities. This group also made slower age-related progress than the control group on tests of perceptual-motor and executive functions. Environmental factors moderated group differences in change on other cognitive measures. These results revealed further evidence for slower skill development in both VLBW groups relative to controls, as well as"catch-up" growth in the 750-1499 g group on some measures. The findings suggest age-related changes in the cognitive sequelae of VLBW that depend on the skill assessed, the degree of VLBW, and environmental factors.

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial

OBJECTIVE

To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD).

METHOD

This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components.

RESULTS

By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up.

CONCLUSIONS

Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.

Exposure-based cognitive-behavioral treatment for phobic and anxiety disorders: treatment effects and maintenance for Hispanic/Latino relative to European-American youths

OBJECTIVE

To examine treatment response and maintenance to exposure-based cognitive-behavioral therapy (CBT) for Hispanic/Latino relative to European-American youths with phobic and anxiety disorders.

METHOD

A total of 131 Hispanic/Latino and European-American youths (aged 6-16 years) who participated in two previous clinical trials for phobic and anxiety disorders were compared along diagnostic recovery rates, clinically significant improvement, and youth- and parent-completed questionnaire scores using traditional hypothesis tests, including effect sizes, and statistical equivalence tests.

RESULTS

After treatment, Hispanic/Latino and European-American youths responded similarly to exposure-based CBT in their diagnostic recovery rates and questionnaires. Effect sizes for questionnaire data were also more similar than different across the two groups. With regard to treatment maintenance, Hispanic/Latino and European-American youths also responded more similarly than differently, albeit with some variations within specific assessment points in questionnaire data.

CONCLUSIONS

Exposure-based CBT for phobic and anxiety disorders produced positive treatment gains and maintenance for Hispanic/Latino youths who participated in the trials. The treatment response that can be expected is generally similar (i.e., favorable) and equivalent to that found with European-American youths based on all the available indices of change.

Youth with anxiety disorders in research and service clinics: examining client differences and similarities

Compared 2 groups of children with anxiety disorders: those treated in a university-based research clinic (RC) and those treated in community-based service clinics (SCs). A widely endorsed goal in intervention research is to disseminate evidence-based treatments from RCs to SCs. Attaining this goal requires an understanding of the similarities and differences between clients in these 2 settings. Youth from SCs showed more comorbid externalizing diagnoses and externalizing problems and were more likely to come from low-income and single-parent families. On measures of internalizing symptomatology and diagnoses, youth from RCs were very similar to SC youth. To facilitate development of treatments with real-world applicability, we describe a model involving the testing of treatments in real-world settings. We also discuss limitations to this project.

Research on information-processing factors in child and adolescent psychopathology: a critical commentary

Provides a critical commentary on the state-of-the-art of research on information-processing (I-P) factors in clinical child and adolescent psychology. The articles in this special section amply demonstrate the value of the I-P paradigm as a heuristic framework for conceptualizing and studying the role(s) of cognitive factors in the etiology and maintenance of child and adolescent psychopathology. However, the current status of such research also reflects a number of limitations that warrant consideration if the potential value of the I-P paradigm is to be fully realized. Specifically, understanding the role(s) played by such factors is impeded by a variety of insufficiently addressed methodological and psychometric issues, as well as by insufficiently articulated theories regarding such factors. These issues are particularly challenging for child and adolescent psychopathology researchers because of the complexities added by development. The value of I-P theories of childhood and adolescent psychopathology will be considerably enhanced if these issues are more fully considered in future research.