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Geiderman JM, Moskop JC, Marco CA, Schears RM, Derse AR. Civility in Health Care: A Moral Imperative. HEC Forum 2024; 36:245-257. [PMID: 36547791 PMCID: PMC11070391 DOI: 10.1007/s10730-022-09501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach.
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Affiliation(s)
- Joel M Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - John C Moskop
- Department of Internal Medicine, Medical Center Blvd, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
- General Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard Winston-Salem, Winston-Salem, NC, 27157, USA.
| | - Catherine A Marco
- Department of Emergency Medicine, Penn State Health - Milton S. Hershey Medical Center,, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Raquel M Schears
- Department of Emergency Medicine, College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Arthur R Derse
- Department of Emergency Medicine, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Kern Institute for the Transformation of Medical Education, M1100, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3548, USA
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Ros-DeMarize R, Boan A, Bradley C, Klein J, Carpenter L. Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01539-4. [PMID: 37171780 DOI: 10.1007/s10578-023-01539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parenting program for disruptive behavior and has been shown to also be effective for children with autism spectrum disorder (ASD). Telehealth delivery of PCIT (Tele-PCIT) is also supported, but no trials have focused on children with ASD. The purpose of the study was to examine the initial efficacy of a time limited version of Tele-PCIT within an ASD sample. METHODS Participants included parents of 20 children (ages 2-6) with ASD who received 10 sessions of Tele-PCIT. Parents reported on their parenting stress, parenting practices, and child behavior. A play observation was coded for parent use of treatment skills and for child compliance. RESULTS 80% of participants completed treatment (n = 16) and results revealed significant improvements across parenting and child outcomes. Parents reported decreases in parenting stress from pre-to-post-treatment, which were maintained at a 3-month follow-up, along with decreases in negative parenting practices (i.e., Laxness and Overactivity) from pre-to-post treatment that were also maintained at follow-up. Significant increases in parent use of positive parenting skills (i.e., "Do" Skills) during child-led play and decreases in negative parenting skills (i.e., "Don't" Skills) were observed. Results also revealed significant reductions in parent rated child externalizing behavior problems from pre-to-post-treatment that were also maintained at follow-up. CONCLUSIONS Results of the current study support the initial efficacy of Tele-PCIT for treating disruptive behavior in young children with ASD. Findings from this pilot will inform larger examinations of Tele-PCIT for youth with ASD.
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Affiliation(s)
- Rosmary Ros-DeMarize
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Andrea Boan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine Bradley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Klein
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Carpenter
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Halliday CA, Perkins KA, Salazar CA, Danielson CK. The Role of Ethnic-Specific Gender Schemas in Ethnic Disparities in Adolescent Girls' Disruptive Behavior: A Preliminary Examination. J Community Med Public Health Rep 2022; 3:10.38207/jcmphr/2022/mar030205271a. [PMID: 37383298 PMCID: PMC10306265 DOI: 10.38207/jcmphr/2022/mar030205271a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
African American adolescent girls have evidenced higher levels of disruptive behavior than girls from other ethnic groups. However, most research focused on understanding disparities in these outcomes has been conducted without consideration of gender or has focused exclusively on boys. Yet, prior research suggests that anger and aggression are less gender-typed in African American youth than they are among youth from other ethnic backgrounds. The purpose of this preliminary investigation was to examine the extent to which ethnic-specific gender schemas about anger mediated the relationship between ethnicity and girls' disruptive behavior. Participants were 66 middle school girls (24.1 % African American, 46.3 % European American; Mage= 12.06). They completed measures of ethnic-specific gender schemas about anger, reactive and instrumental aggression, and classroom disruptive behavior. Results indicated that relative to girls from other ethnic groups, African American girls had higher levels of reactive aggression and classroom disruptive behavior, both of which are rooted in anger. In contrast, no ethnic difference was found for instrumental aggression, which is not connected to anger. Ethnic-specific gender schemas about anger at least partially accounted for ethnic differences in reactive aggression and classroom disruptive behavior. Findings highlight the importance of examining gender schemas specific to ethnicity as factors in ethnic disparities in behavioral outcomes among adolescent girls.
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Affiliation(s)
- Colleen A Halliday
- Division of Global and Community Health, Department of Psychiatry & Behavioral Science, Medical University of South Carolina
| | - Katherine A Perkins
- Yvonne and Schuyler Moore Child Development Research Center, College of Education, University of South Carolina
| | - Claudia A Salazar
- Group on Diversity Affairs, College of Medicine Dean's Office, Medical University of South Carolina
| | - Carla Kmett Danielson
- National Crime Victims and Treatment Center, Department of Psychiatry & Behavioral Science, Medical University of South Carolina
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Gaete J, Sametband I, St George S, Wulff D, Tomm K, Durán G. Realizing Relational Preferences Through Transforming Interpersonal Patterns. Fam Process 2020; 59:21-35. [PMID: 30552779 DOI: 10.1111/famp.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Family therapy has often been conceptualized as a conversational process whereby therapists and clients generate new meanings. Based on a 3-year study of conversational practices observable in successful family therapy processes of Chilean families with a child/adolescent who is engaged in disruptive behaviors, we looked for clinical examples of Transforming Interpersonal Patterns (TIPs). TIPs are a key aspect of the IPscope, a framework we used to explore the meaning-making processes in family therapy. TIPs constitute a novel approach to explore therapeutic processes by identifying empirically traceable conversational practices involved in generating "new meanings." TIPs are involved in bringing forth and discursively articulating ("talking-into-being") clients' preferred ways of relating and living (i.e., relational preferences or RPs). We analyze conversational data from successful family therapy sessions/treatments, and present an emergent model of five categories of conversational practices making up TIPs, namely: Preparatory TIPs, Identifier TIPs, Tracker TIPs, Transformer TIPs, and Consolidator TIPs. We have called them "realizers" because these conversational practices help families talk-into-being (or "make real") particular relational preferences. We also offer user-friendly descriptors of realizers' subcategories (e.g., Measuring TIPs) which may help practitioners to recognize, learn, and perform these conversational invitations. Theoretical consequences and future lines of research are discussed.
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Affiliation(s)
- Joaquín Gaete
- School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Inés Sametband
- School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Sally St George
- University of Calgary and the Calgary Family Therapy Centre, Calgary, AB, Canada
| | - Dan Wulff
- University of Calgary and the Calgary Family Therapy Centre, Calgary, AB, Canada
| | - Karl Tomm
- University of Calgary and the Calgary Family Therapy Centre, Calgary, AB, Canada
| | - Gabriela Durán
- School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
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Ortiz C, Vidair H, Acri M, Chacko A, Kobak K. Pilot Study of an Online Parent-Training Course for Disruptive Behavior with Live Remote Coaching for Practitioners. ACTA ACUST UNITED AC 2020; 51:125-133. [PMID: 34017154 DOI: 10.1037/pro0000286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al., 2017). Workshops, ongoing consultation, and feedback provided in person are effective, yet are rarely feasible for clinicians in the field (Fixsen, Blase, Duda, Naoom, & Van Dyke, 2010). The purpose of the present study was to conduct a preliminary assessment of an online tutorial combined with live remote coaching for training mental health professionals in behavioral parent training. Method Participants in this pretest-posttest open trial were 22 clinicians and graduate students (73% female) from around the United States. Results The web platform operated successfully, and clinicians found the training to be highly satisfactory. Compared to pre-training, participants demonstrated large improvements in knowledge about disruptive behavior and behavioral parent training and performed significantly better on demonstrations of skill in administering behavioral parent-training components. Conclusions An online course combined with live remote coaching is a promising methodology for significantly increasing the number of clinicians trained in evidence-based interventions for disruptive behavior in children. Next steps for evaluation and expansion of this training model are discussed.
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Kaat AJ, Blackwell CK, Estabrook R, Burns JL, Petitclerc A, Briggs-Gowan MJ, Gershon RC, Cella D, Perlman SB, Wakschlag LS. Linking the Child Behavior Checklist (CBCL) with the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB): Advancing a dimensional spectrum approach to disruptive behavior. J Child Fam Stud 2019; 28:343-353. [PMID: 31452592 PMCID: PMC6709983 DOI: 10.1007/s10826-018-1272-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disruptive behavior in childhood is common. It spans from normative child misbehaviors to clinically-significant and impairing problems. While there are many rating scales evaluating such behaviors, historically, measurement has emphasized counting the number of symptoms present rather than assessing the normal-abnormal spectrum of behavioral expression. This study uses data from 644 early school age children aggregated from two data sources to statistically link a commonly used symptom count measure, the Child Behavior Checklist (CBCL), to a more developmentally-sensitive measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). Two links between conceptually similar scales on each measure were developed: CBCL Conduct Problems and MAP-DB Aggression; and CBCL Oppositional Defiant Problems and MAP-DB Temper Loss. We compared two innovative methods-Item Response Theory (IRT) and Deming regression-to determine the optimal linking relationship. Results suggest IRT methods were superior in reducing linking error compared to Deming regression. While Deming regression accurately modeled the mean scores (thus minimizing linking bias), this method could not adequately address the floor effect for scores on the CBCL. For practical purposes, this study provides a crosswalk of score conversions between the CBCL and MAP-DB, such that data aggregation and group comparisons can be made across the two measures; this enables longitudinal analyses with historically-collected CBCL data to transition to the more innovative dimensional scales of the MAP-DB without undo loss of extant data. This study furthers efforts to shift from historical symptom counts to more developmentally-sensitive measurement across the disruptive behaviors spectrum.
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Affiliation(s)
- Aaron J Kaat
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Courtney K Blackwell
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Ryne Estabrook
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - James L Burns
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Amelie Petitclerc
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | | | - Richard C Gershon
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - David Cella
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Susan B Perlman
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
| | - Lauren S Wakschlag
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
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Higa-McMillan C, Kotte A, Jackson D, Daleiden EL. Overlapping and Non-overlapping Practices in Usual and Evidence-Based Care for Youth Anxiety. J Behav Health Serv Res 2018; 44:684-694. [PMID: 26945583 DOI: 10.1007/s11414-016-9502-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study compared consistencies and discrepancies in usual care with practices derived from the evidence-base (PDEB) for youth anxiety in a public mental health system. Youth-level factors (diagnosis, functional impairment) as predictors of the discrepancies were also examined. Psychosocial and service data from 2485 youth with an anxiety disorder and/or receiving services for an anxiety treatment target were extracted. Therapists (N = 616) identified the treatment targets and practices youth received. Although many PDEB for youth anxiety were used by therapists in this sample, Exposure was only used in 15% of cases. Practices not consistent with youth anxiety treatment were also reported and included: PDEB for other conditions, practices common to all therapies, and practices that are not consistent with evidence-based care. Age and diagnosis predicted the delivery of PDEB for youth anxiety. Usual care incorporated many components of evidence-based care but was more diffuse and less focused on well-supported practices.
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Affiliation(s)
| | - Amelia Kotte
- University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - David Jackson
- University of Hawai'i at Mānoa, Honolulu, HI, USA.,Hawai'i Department of Health, Child and Adolescent Mental Health Division, Honolulu, HI, USA
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Freedman R. Alcohol Use in a Study of Phosphatidylcholine Supplementation in Pregnancy: Response to Bell and Ajula. Am J Psychiatry 2018; 175:578-579. [PMID: 29869549 DOI: 10.1176/appi.ajp.2018.18020147r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Freedman
- From the Department of Psychiatry, University of Colorado School of Medicine, Aurora
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Wakschlag LS, Pine DS. The Role of Perinatal Risk in Neurodevelopmental Pathways to Early Childhood Disruptive Behavior: Response to Bell and Ajula. Am J Psychiatry 2018; 175:578. [PMID: 29869548 DOI: 10.1176/appi.ajp.2018.18020147r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren S Wakschlag
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; and the National Institute of Mental Health, Bethesda, Md
| | - Daniel S Pine
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; and the National Institute of Mental Health, Bethesda, Md
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Bell CC, Ajula J. Where Is the Discussion About Choline and Fetal Alcohol Exposure? Am J Psychiatry 2018; 175:577-578. [PMID: 29869550 DOI: 10.1176/appi.ajp.2018.18020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carl C Bell
- From the Department of Psychiatry, Jackson Park Hospital, Chicago
| | - Jessie Ajula
- From the Department of Psychiatry, Jackson Park Hospital, Chicago
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Wakschlag LS, Perlman SB, Blair RJ, Leibenluft E, Briggs-Gowan MJ, Pine DS. The Neurodevelopmental Basis of Early Childhood Disruptive Behavior: Irritable and Callous Phenotypes as Exemplars. Am J Psychiatry 2018; 175:114-130. [PMID: 29145753 PMCID: PMC6075952 DOI: 10.1176/appi.ajp.2017.17010045] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].
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Affiliation(s)
- Lauren S Wakschlag
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Susan B Perlman
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - R James Blair
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Ellen Leibenluft
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Margaret J Briggs-Gowan
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Daniel S Pine
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
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