Exploring the relationships between resilience, mindfulness, and experiential avoidance after the use of a mindfulness- and acceptance-based mobile app for posttraumatic stress disorder

PURPOSE

This study used a mindfulness- and acceptance-based mobile app to examine the relationships between resilience, mindfulness, experiential avoidance, and posttraumatic stress disorder (PTSD) symptoms.

DESIGN AND METHODS

A quasi-experimental pre-posttest, single-group study design was used. A total of 23 college student veterans used the app for 4 weeks. Outcomes of resilience, mindfulness, experiential avoidance, and PTSD were measured at three time-points (baseline, end of Week 2, and end of Week 4).

FINDINGS

All outcomes significantly improved at postintervention. Improvements in resilience and PTSD significantly correlated with improvement in mindfulness.

PRACTICE IMPLICATIONS

Mindfulness- and acceptance-based mobile apps can be safely used by individuals with PTSD as a complementary approach to enhance resilient coping with PTSD.

The Heterogeneity of Selective Mutism: A Primer for a More Refined Approach

Selective mutism is a persistent and debilitating psychiatric disorder in which a child fails to speak in situations where speaking is expected. Although listed as an anxiety disorder, the multifaceted and heterogeneous nature of selective mutism indicates that a more accurate conceptualization may be as a neurodevelopmental disorder. This article serves as a primer of historical and clinical presentations, empirical clinical profiles, clinical distinctions, assessment, and treatment related to the complexity of selective mutism. The article includes a brief discussion of selective mutism within a developmental psychopathology perspective with an eye toward reformed efforts for prevention, assessment, and treatment regarding this population.

A multi-tiered systems of support blueprint for re-opening schools following COVID-19 shutdown

The COVID-19 pandemic will create enormous disruptions for youth and families with respect to economic and health status, social relationships, and education for years to come. The process of closing and intermittently reopening schools adds to this disruption and creates confusion for parents and school officials who must balance student educational progress with health and safety concerns. One framework that may serve as a roadmap in this regard is a multi-tiered systems of support (MTSS) model. This article briefly addresses four main domains of functioning (adjustment, traumatic stress, academic status, health and safety) across three tiers of support (universal, targeted, intensive). Each section draws on existing literature bases to provide specific recommendations for school officials who must address various and changing logistical, academic, and health-based challenges. The recommendations are designed to be flexible given fluctuations in the current crisis as well as focused on maximum-value targets. An MTSS approach adapted for contemporary circumstances can also be used to help address longstanding disparities that have been laid bare by the pandemic.

The School Climate and Academic Mindset Inventory (SCAMI): Confirmatory Factor Analysis and Invariance Across Demographic Groups

School climate is a multidimensional construct of the quality of a student’s academic environment, often subsuming dimensions such as safety, instructional practices, social relationships, school facilities, and school connectedness. Positive school climate has beneficial effects on a wide range of adjustment variables in youth, including academic achievement, mental health, school attendance and graduation, and school-based behavior. Studies regarding school climate assessment have burgeoned in recent years but remain marked by limited sample sizes, narrow developmental levels, restricted items, unclear psychometric strength across multiple demographic groups, and lack of integration with key student education contextual factors such as academic mindset and social emotional learning. The present study evaluated a comprehensive measure of aspects of school climate, academic mindset, and social emotional learning in a sample of 105,379 diverse students (M_age = 13.47 years; SD = 2.47). The 9-factor structure of the School Climate and Academic Mindset Inventory was supported via confirmatory factor analysis. A trimmed model displayed adequate goodness-of-fit for males and females, younger age groups, and European American, biracial/multiracial, Hispanic, Native American, and Native Hawaiian/Pacific Islander students. The trimmed model was slightly less strong for older age groups as well as for African American and Asian American students. The scale may be useful for assessing school climate interventions, longitudinal climate patterns, and school-based algorithms of future performance, though additional validation of the scale remains necessary.

Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

School attendance problems are highly prevalent worldwide, leading researchers to investigate many different risk factors for this population. Of considerable controversy is how internalizing behavior problems might help to distinguish different types of youth with school attendance problems. In addition, efforts are ongoing to identify the point at which children and adolescents move from appropriate school attendance to problematic school absenteeism. The present study utilized ensemble and classification and regression tree analysis to identify potential internalizing behavior risk factors among youth at different levels of school absenteeism severity (i.e., 1+%, 3+%, 5+%, 10+%). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 160 youth aged 6-19 years (M = 13.7; SD = 2.9) and their families from an outpatient therapy clinic (39.4%) and community (60.6%) setting, the latter from a family court and truancy diversion program cohort. One particular item relating to lack of enjoyment was most predictive of absenteeism severity at different levels, though not among the highest levels. Other internalizing items were also predictive of various levels of absenteeism severity, but only in a negatively endorsed fashion. Internalizing symptoms of worry and fatigue tended to be endorsed higher across less severe and more severe absenteeism severity levels. A general expectation that predictors would tend to be more homogeneous at higher than lower levels of absenteeism severity was not generally supported. The results help confirm the difficulty of conceptualizing this population based on forms of behavior but may support the need for early warning sign screening for youth at risk for school attendance problems.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2)

As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.

Family Environment Variables as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

School attendance problems, including school absenteeism, are common to many students worldwide, and frameworks to better understand these heterogeneous students include multiple classes or tiers of intertwined risk factors as well as interventions. Recent studies have thus examined risk factors at varying levels of absenteeism severity to demarcate distinctions among these tiers. Prior studies in this regard have focused more on demographic and academic variables and less on family environment risk factors that are endemic to this population. The present study utilized ensemble and classification and regression tree analysis to identify potential family environment risk factors among youth (i.e., children and adolescents) at different levels of school absenteeism severity (i.e., 1 + %, 3 + %, 5 + %, 10 + %). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 341 youth aged 5-17 years (M = 12.2; SD = 3.3) and their families from an outpatient therapy clinic (68.3%) and community (31.7%) setting, the latter from a family court and truancy diversion program cohort. Family environment risk factors tended to be more circumscribed and informative at higher levels of absenteeism, with greater diversity at lower levels. Higher levels of absenteeism appear more closely related to lower achievement orientation, active-recreational orientation, cohesion, and expressiveness, though several nuanced results were found as well. Absenteeism severity levels of 10-15% may be associated more with qualitative changes in family functioning. These data may support a Tier 2-Tier 3 distinction in this regard and may indicate the need for specific family-based intervention goals at higher levels of absenteeism severity.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1)

School attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Many efforts have been made to conceptualize and address this population across various categories and dimensions of functioning and across multiple disciplines, resulting in both a rich literature base and a splintered view regarding this population. This article (Part 1 of 2) reviews and critiques key categorical and dimensional approaches to conceptualizing school attendance and school absenteeism, with an eye toward reconciling these approaches (Part 2 of 2) to develop a roadmap for preventative and intervention strategies, early warning systems and nimble response, global policy review, dissemination and implementation, and adaptations to future changes in education and technology. This article sets the stage for a discussion of a multidimensional, multi-tiered system of supports pyramid model as a heuristic framework for conceptualizing the manifold aspects of school attendance and school absenteeism.

Student Veterans' Coping with Posttraumatic Stress Symptoms: A Glaserian Grounded Theory Study

The present study investigated the ways in which student military veterans cope with their posttraumatic stress symptoms. The participants were a total of 21 military veterans attending a U.S. university. The results of the grounded theory data analysis reveal the core category of modulating intrusions, a process indicating how student veterans cope with recurrent and unwanted posttraumatic stress experiences. Our findings also demonstrate that veterans cope by either avoiding or allowing themselves to experience the pain associated from their traumatic experiences. The proposed framework can be meaningfully used to facilitate the development of adaptive coping among veterans with posttraumatic stress.

Relationship between school refusal behavior and social functioning: a cluster analysis approach

On the basis of the heterogeneous casuistry that characterizes the students who refuse going to school, it is useful to have a classification of this population in homogeneous groups. For this, the aim of this study was, first, to identify by cluster analysis the profiles of school refusal behavior based on the functional model evaluated through the School Refusal Assessment Scale-Revised (SRAS-S). Secondly, it is intended to analyze if there are differences in social functioning scores according to the school refusal profiles identified. This study involved 1212 Spanish children between 8 and 11 years old (M=9.12, SD=1.05) who completed the SRAS-R to evaluate the school refusal behavior and the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) to assess social functioning. Four profiles were identified: Non-school refusers, School refusers by mixed reinforcements, School refusers by tangible reinforcements and School refusers by negative reinforcements. The profile of Non-school refusers achieved the highest average scores in social functioning, while School refusers by mixed reinforcements group obtained the lowest average scores in social functioning. In general, the profiles found support the clusters identified in previous studies. The implications of social functioning on school refusal behavior are discussed.

Latent Class Symptom Profiles of Selective Mutism: Identification and Linkage to Temperamental and Social Constructs

Selective mutism (SM) is a stable, debilitating psychiatric disorder in which a child fails to speak in most public situations. Considerable debate exists as to the typology of this population, with empirically-based studies pointing to possible dimensions of anxiety, oppositionality, and communication problems, among other aspects. Little work has juxtaposed identified symptom profiles with key temperamental and social constructs often implicated in SM. The present study examined a large, diverse, non-clinical, international sample of children aged 6-10 years with SM to empirically identify symptom profiles and to link these profiles to key aspects of temperament (i.e., emotionality, shyness, sociability, activity) and social functioning (i.e., social problems, social competence). Exploratory and confirmatory factor analysis revealed anxiety/distress, oppositionality, and inattention domains. In addition, latent class analysis revealed nuanced profiles labeled as (1) moderately anxious, oppositional, and inattentive, (2) highly anxious, and moderately oppositional and inattentive, and (3) mildly to moderately anxious, and mildly oppositional and inattentive. Class 2 was the most impaired group and was associated with greater emotionality, shyness, and social problems. Class 3 was the least impaired group and was associated with better sociability and social competence and activity. Class 1 was largely between the other classes, demonstrating less shyness and social problems than Class 2. The results help confirm previous findings of anxiety and oppositional profiles among children with SM but that nuanced classes may indicate subtle variations in impairment. The results have implications not only for subtyping this population but also for refining assessment and case conceptualization strategies and pursuing personalized and perhaps less lengthy treatment.

Interventions for Posttraumatic Stress with Resilience as Outcome: An Integrative Review

This integrative review explores the current state of knowledge on trauma-focused interventions with resilience as the outcome. The review synthesized the results of 17 intervention studies. Findings of the review demonstrate the importance of including resilience as an outcome measure for the effectiveness of trauma-focused interventions. Findings also provide preliminary evidence that effective trauma-focused interventions both reduce posttraumatic stress disorder (PTSD) symptoms and improve resilience. Further research should include a focus on developing interventions based on established theoretical frameworks, and using resilience outcome measurement tools appropriate to the interventions and the characteristics of the target population.

Student veterans' construction and enactment of resilience: A constructivist grounded theory study

WHAT IS KNOWN ON THE SUBJECT?: Resilience is an ability and a process that allows an individual to develop positive adaptation despite challenges and adversities. Many military veterans returning to college after their military service have difficulty transitioning to civilian life. Although some research exists that explores factors related to the resilience of college student veterans, limited theoretical descriptions exist that explain how student veterans construct resilience, and how resilience is enacted and enhanced in their academic and personal (non-academic) lives. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The resilience of student veterans involves a complex process of transitioning from military to civilian life and an iterative journey between positive adaptation and transient perturbations. Student veterans' resilience is a result of integrating and resolving various aspects of their academic and personal challenges. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can apply this grounded theory as a practical framework for equipping student veterans with effective strategies to develop and enhance resilience. Nurses can employ a holistic approach of care in their interactions with military veterans and student veterans that includes fostering psychological resilience, helping to manage their multiple non-academic responsibilities and supporting their academic success.

ABSTRACT

Introduction Adjusting to college life is one of the most difficult experiences in a military veteran's transition to civilian life. Many military veterans returning to college not only encounter academic challenges, but also deal with physical and psychiatric disabilities, loss of military camaraderie and social disconnect. These often negatively affect their personal and academic lives. Hence, it is important to explore resilience to best support student veterans as they transition from military to civilian life. Aim The aim of this study was to explore how student veterans construct and enact resilience within their personal and academic lives. Method Using constructivist grounded theory methodology, in-depth individual interviews were conducted with 20 military veterans enrolled as undergraduate students at a U.S. university. Results The process of "integrating," which represents student veterans' construction and enactment of resilience, was the core category. This category has three subcategories: (1) the aspects; (2) the expressions; and (3) the enactments of resilience. Implications for practice Nurses can use this grounded theory as the practical framework for their interactions with military veterans, and more particularly with supporting student veterans in their academic lives, in their personal lives and in the transition from military to civilian life.

Posttraumatic symptoms among maltreated youth using classification and regression tree analysis

Individual psychological factors have been shown to exacerbate risk for posttraumatic stress disorder (PTSD) symptoms in youth following maltreatment, but the novel contribution of the present study includes a focus on interactive relationships between these factors on specific PTSD symptom clusters. This study identified maltreated youth at highest risk for re-experiencing, avoidance, and hyperarousal symptom clusters via cognitive, affective, and demographic variables. Participants (n=400) included ethnically diverse maltreated youth. Classification and regression tree (CART) analysis, a form of binary recursive partitioning (BRP), identified subgroups of maltreated youth at highest risk for three core PTSD symptom clusters. Posttraumatic cognitions, anhedonia, negative mood, processing speed, and ethnicity best predicted re-experiencing symptoms. Depersonalization/derealization, verbal comprehension, sexual maltreatment, and age best predicted avoidance symptoms. Negative cognitions about self, IQ, dissociation, working memory, and posttraumatic cognitions best predicted hyperarousal symptoms. Core PTSD symptom clusters may thus be associated with unique collections of risk factors for maltreated youth. Clinical protocols for this population could be recalibrated to be more sensitive to specific profiles that more accurately identify highest risk maltreated youth and better inform evidence-based treatment practices.

School Refusal Assessment Scale–Revised Chilean Version: Factorial Invariance and Latent Means Differences Across Gender and Age

The School Refusal Assessment Scale–Revised (SRAS-R) is a self-report measure designed to assess four functional factors of school refusal behavior: avoidance of stimuli that provoke negative affectivity (Factor I), escape from aversive social and/or evaluative situations (Factor II), pursuit of attention from significant others (Factor III), and pursuit of tangible reinforcement outside of school (Factor IV). The aim was to analyze the scale’s factorial invariance and latent means differences across gender and age in a sample of 2,678 Chilean adolescents aged 13 to 17 years ( M = 15.23; SD = 1.26). The hypothesized model revealed the best-fit model and remained invariant across gender and age. Good internal consistency was obtained for the four factors (.75, .72, .77, and .71). Latent means differences were found across gender and age.

Personalized Individual and Group Therapy for Multifaceted Selective Mutism

Selective mutism refers to a persistent and debilitating condition in which a child fails or refuses to speak in public situations. Research on treatment for selective mutism has progressed in recent years toward a more personalized model based on clinical profiles unique to a given child. Such profiles may include aspects of anxiety, oppositional behaviors, and communication problems as well as operant factors that maintain selective mutism. The present case represents a 6-year-old child with selective mutism with a multifaceted clinical profile that included internalizing and externalizing behavior problems with multiple operant factors. Initial personalized individual therapy focused on anxiety and contingency management procedures to address school refusal behavior and to lay the groundwork for later treatment of selective mutism. Group therapy with parent and child components focused on these procedures in more detail in addition to social skills development. Each component included detailed hierarchies for increasing frequency and audibility of speech in a clinic setting as well as in community and school settings.

School Refusal Assessment Scale-Revised: Factorial Invariance and Latent Means Differences across Gender and Age in Spanish Children

The aim of this study was to analyze the factorial invariance and latent means differences of the Spanish version of the School Refusal Assessment Scale-Revised for Children (SRAS-R-C) in a sample of 1,078 students (50.8% boys) aged 8-11 years (M = 9.63, SD = 1.12). The results revealed that the proposed model in this study, with a structure of 18 items divided into four factors (Negative Affective, Social Aversion and/or Evaluation, To Pursue Attention and Tangible Reinforcements), was the best-fit model with a tetra-factorial structure, remaining invariant across gender and age. Analysis of latent means differences indicated that boys and 11-year-old students scored highest on the Tangible Reinforcements subscale compared with their 8- and 9-year-old peers. On the contrary, for the subscales of Social Aversion and/or Evaluation and to Pursue Attention, the differences were significant and higher in younger age groups compared to 11-year-olds. Appropriate indexes of reliability were obtained for SRAS-R-C subscales (0.70, 0.79, 0.87, and 0.72). Finally, the founded correlation coefficients of scores of the SRAS-R-C revealed a predictable pattern between school refusal and positive/negative affect and optimism/pessimism.

Interrater Reliability of the Motivation Assessment Scale: Another, Closer Look

Recent evidence indicates that the Motivation Assessment Scale (MAS), designed by Durand and Crimmins (1988) to measure influential maintaining variables of maladaptive behavior, is associated with inadequate interrater reliability. In this study, interrater reliability of the MAS was reinvestigated utilizing direct-care staff members familiar with persons with mental retardation. Problematic overt behaviors were evaluated in 42 adults in southern Nevada. MAS items were found to be reliable moderately but significantly across raters. Variables that affect reliability, including low or high behavior frequency, differential training procedures for raters, and setting selection should be considered closely by MAS administrators.

The Functional Profiles of School Refusal Behavior

School refusal behavior is a common problem seen by mental health professionals and by educators but little consensus is available as to its classification, assessment, and treatment. This study assessed 143 youth with primary school refusal behavior and their parents to examine diagnoses that are most commonly associated with proposed functions of school refusal behavior. As expected, results indicated that great heterogeneity in diagnoses marks this population. In general, anxiety-related diagnoses were associated more with negatively reinforced school refusal behavior; separation anxiety disorder was associated more with attention-seeking behavior; and oppositional defiant disorder and conduct disorder were associated more with pursuit of tangible reinforcement outside of school. These results are discussed within the context of classification, assessment, and treatment of this population.

Case Study of the Assessment and Treatment of a Youth With Multifunction School Refusal Behavior

School refusal behavior is a common problem among children and adolescents and can lead to serious short- and long-term consequences if not addressed. Although recent treatment outcome studies have targeted youth who refuse to go to school for one specific reason (e.g., anxiety, attention), very little information is available on youth who refuse school for two reasons, and no information is available on youth who refuse school for three reasons. This article reports on the successful treatment of a 12-year-old boy who received prescriptive treatment for multifunction school refusal behavior. The treatment was assigned in accordance with a set assessment strategy designed to identify the primary reasons why a particular child refuses to attend school.

Assessment and Treatment of a Hispanic Youth With Selective Mutism

Selective mutism can be a potentially debilitating mental disorder that affects about 1% of youth. Unfortunately, this population remains under-researched, and very little information is available regarding the treatment of diverse youth with selective mutism. This article reports on the successful treatment of a 10-year-old Hispanic female with selective mutism. Treatment was largely behavioral in nature and consisted of exposure-based practices and contingency management.

Anxiety and oppositional behavior profiles among youth with selective mutism

Selective mutism (SM) is a debilitating condition in which a child does not speak in social situations where speech is expected. The clinical conceptualization of SM has been debated historically, with evidence pointing partly to anxious and oppositional behavior profiles. Behavioral characteristics were examined in a clinical sample of 57 youth formally diagnosed with selective mutism. Parents rated children across internalizing and externalizing behaviors on the Child Behavior Checklist. Eighteen highly rated items were subjected to exploratory and then confirmatory factor analysis. Anxiety and oppositional behavior factors were derived. The anxious behavior profile was associated with social anxiety disorder symptoms, social problems, and aggressive behaviors but not oppositional defiant disorder symptoms. The oppositional behavior profile was associated with aggressive behaviors, oppositional defiant disorder symptoms, social problems, and inversely to social anxiety disorder symptoms. Results are consistent with emerging research regarding subgroups of children with SM. Behavior profiles are discussed as well with respect to assessment and treatment implications.

LEARNING OUTCOMES

Readers will learn about the nature of children with selective mutism as well as behaviors that differentiate anxious and oppositional behavior profiles. Items that comprise anxious and oppositional behavior profiles are presented. These item profiles may have ramifications for assessment and treatment.

Risk-taking/gambling-like behavior in preschool children

The types and characteristics of risk-taking or gambling-like behaviors in children are not well understood. Social learning, as one potential etiological factor of risktaking behavior in preschool children, was empirically examined. Prior to playing a risk-taking game, children in the experimental group were exposed to a peer model who had ostensibly won a large prize, whereas control children were exposed to a peer model who had won nothing. Children in the experimental group initiated more risks to win the large prize in the high-risk situation than children in the control group. The results indicated that modeling can enhance risk-taking/gambling-like behavior in young children. Parallels to compulsive gambling in adults, and recommendations for future research were also discussed.

Posttraumatic stress and related symptoms among neglected and physically and sexually maltreated adolescents

Posttraumatic stress disorder (PTSD) is common among maltreated youth, but few investigations compare neglect with other maltreatment types. This study examined 84 adolescents who experienced neglect only, physical and/or sexual maltreatment only, or neglect with physical and/or sexual maltreatment. Symptoms of PTSD, dissociation, and depression were measured. Adolescents who experienced physical and/or sexual maltreatment, whether neglected or not, reported significantly greater symptomatology than adolescents who experienced neglect only (η2 = .094). This difference applied to PTSD symptoms, dissociative amnesia, depersonalization and derealization, negative mood, and anhedonia. Adolescents exposed to neglect only displayed substantial psychopathology but less than that of other groups. The findings may reflect emerging cascade models of the etiology of symptoms of PTSD following extensive maltreatment history.

Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.

School absenteeism and school refusal behavior in youth: A contemporary review

Absenteeism from school is a serious public health issue for mental health professionals, physicians, and educators. The prevalence of unexcused absences from school exceeds that of major childhood behavior disorders and is a key risk factor for violence, injury, substance use, psychiatric disorders, and economic deprivation. This article involves a contemporary research review on absenteeism prevalence, comorbid physical and psychiatric conditions, classification, contextual risk factors, cross-cultural variables, assessment, intervention, and outcome. Contextual risk factors include homelessness and poverty, teenage pregnancy, school violence and victimization, school climate and connectedness, parental involvement, and family variables, among others. A description of intervention includes medical, clinical, and systemic interventions. Medical professionals, community- and school-based mental health professionals, and educators are encouraged to fully understand the parameters of school absenteeism to develop better, consensual policies regarding definition, classification, assessment, and intervention of youths with problematic school absenteeism.

Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity

BACKGROUND

School refusal behavior is a particularly nettlesome problem for mental health and education professionals because of its symptom severity and heterogeneity as well as lack of consensus regarding inclusive classification strategies. Alternatively, a functional model of school refusal behavior may provide a particularly useful way of organizing, assessing, and treating this population.

METHOD

The present study included 222 youths aged 5-17 years (134 males, 88 females) with school refusal behavior and their parents. Participants were assessed at a specialized university-based clinic for youths with school refusal behavior. Child self-report and parent-based measures of forms of behavior related to school refusal as well as functions of school refusal behavior were employed.

RESULTS

Hierarchical regression analysis and structural equation modeling revealed that function was a better determinant of degree of school absenteeism than behavior form.

CONCLUSIONS

Assessing the function of school refusal behavior is likely a key factor in the evaluation of this population and may be linked to informed decisions about choice of treatment.

Depression and ethnicity as intermediary variables among dissociation, trauma-related cognitions, and PTSD symptomatology in youths

The study of childhood posttraumatic stress disorder (PTSD) has grown in recent years, and several variables have been closely linked to the etiology of this condition. Prominent examples include dissociation, trauma-related cognitions, and depression, but no empirically based model regarding these variables has been presented. We examined 90 adolescents housed in a state-run facility for youths who experienced maltreatment, violence, and/or other traumas. Utilizing psychometrically strong dependent measures, we identified a structural equation model with depression as a key mediating variable between (1) dissociation and trauma-related cognitions and (2) PTSD symptomatology. In addition, African American status was found to weaken this relationship, whereas multiracial status was found to strengthen this relationship. These results are discussed within the context of contemporary integrative theories regarding the developmental psychopathology of PTSD in youths.

School absenteeism and school refusal behavior: a review and suggestions for school-based health professionals

School absenteeism and school refusal behavior are particularly difficult problems that school health professionals often face. Unfortunately, few recommendations are available to such professionals about how to address this population. In this article, we (1) outline the major characteristics of school absenteeism and school refusal behavior, (2) review school-based health programs that have been designed in part to reduce absenteeism, and (3) provide suggestions for school health professionals regarding individual youths with school refusal behavior.

Post-traumatic stress disorder in maltreated youth: a study of diagnostic comorbidity and child factors

The study of post-traumatic stress disorder (PTSD) in maltreated youth has received increased attention, though extensive comparisons to maltreated youth without PTSD and administrations of anxiety-based structured diagnostic interviews remain needed. We examined maltreated youth with or without PTSD using structured diagnostic interviews and standardized child self-report measures. We hypothesized that maltreated youth with PTSD, compared to their peers without PTSD, would experience significantly greater duration of abuse, diagnostic comorbidity, PTSD symptomatology, dysfunctional family environment, and avoidant coping styles. Results indicated that the group with PTSD did indeed experience significantly greater duration of abuse, diagnostic comorbidity, and PTSD symptomatology, though less so dysfunctional family environment or avoidant coping styles. The presence of a mood or anxiety disorder was highly predictive of PTSD in this sample. Results are discussed within the context of evolving etiological and maintenance models of PTSD in maltreated youth.

Parental expectancies and childhood anxiety disorders: psychometric properties of the Parental Expectancies Scale

The current study examined the psychometric properties of the Parental Expectancies Scale (PES) in childhood anxiety disorder and normative samples. The PES is a 20-item self-report instrument that assesses five dimensions of parental expectancies in academic, extra-curricular, household, social, and general success areas. Results indicated that the PES has high test-retest reliability and internal consistency. Regarding validity, PES subscale scores discriminated clinical and normative groups. Principal component and confirmatory factor analyses supported the construct validity of the scale. The PES appears to be a reliable and valid instrument for quantifying parental expectancies. Implications as to case formulation and prescriptive treatment planning with anxious youth are discussed.

Separation anxiety disorder in young children: a longitudinal and family analysis

We conducted a longitudinal study of young children with clinical, subclinical, or nonclinical levels of separation anxiety to evaluate the diagnostic stability and concomitant parent and family variables of separation anxiety disorder (SAD). Youngsters were assessed at age 3 years (n = 60) and 3.5 years later (n = 44). Data were collected from children, parents, teachers, and clinicians. Results revealed that most diagnoses of SAD were not stable during this developmental period, as many children drifted toward subclinical or nonclinical status. In addition, children with clinical SAD, compared to those with subclinical SAD or no symptoms of SAD, had a disproportionately higher number of comorbid diagnoses and experienced significantly greater somatic concerns, anxiety, and general internalizing behavior. In addition, their parents experienced greater depression, obsessive-compulsive behavior, phobic anxiety, and general distress. The results preliminarily support prior findings that most children experience a dissipation of SAD symptoms in young childhood but that some children continue to experience stable, significant distress. The results are consistent with prior research on older children that SAD remits for many but not all youth and suggest that parent and family variables may have much to do with cases of poor remission in this population.