My First Time Hurt: Using Preschool PTSD Treatment to Address PTSD Symptoms in a Young Girl With a History of Pediatric Cancer

This case study followed a 4-year-old Caucasian female in cancer remission who presented with symptoms of posttraumatic stress disorder (PTSD). Given the age of this young girl and the health difficulties that she experienced, the preschool PTSD treatment (PPT) manual was implemented to address her distressing symptoms. In addition, it was important to include this young girl’s primary caregiver at each step of the treatment process. Following treatment, this young girl demonstrated significant improvement in her symptomology, as measured quantitatively and qualitatively. Further, this young girl was able to utilize the skills and techniques that she learned and generalize them to other circumstances that caused discomfort or emotional difficulty for her. This case study also demonstrated that incorporating intensive parental involvement with PPT can further the reduction of PTSD symptoms in young children who have experienced medically related trauma.

Be Your Own Superhero: A Case of a Young Boy With Selective Mutism and Complex Comorbidities

This case study outlines the treatment of a 5-year-old Caucasian male who presented with symptoms of selective mutism (SM) along with significant impairment related to comorbid anxiety and speech difficulties. To address these symptoms, Integrated Behavior Therapy for Selective Mutism (IBTSM) was utilized for the treatment of this young boy’s SM and comorbid anxiety. An attachment focus was incorporated as a framework for conceptualizing his SM symptoms. As the treatment of this young boy’s symptoms proceeded, it became clear that his underlying speech difficulties needed to be addressed as well, as these difficulties were preventing expected progress to occur. Thus, this young boy’s treatment was individualized to fit his unique difficulties. In shifting the treatment focus to “being brave like a superhero,” significant decreases were achieved in this young boy’s overall internalizing and Diagnostic and Statistical Manual of Mental Disorders ( DSM)-related anxiety symptoms, facilitating a successful transition to speech and language therapy. This case study is distinctive in its description of the complexities that may come along with treating symptoms that appear consistent with SM along with other comorbid conditions and nuanced circumstances.

Cognitive-Behavioral Treatment of PTSD With a Young Boy and His Mother Following the Experience of Chronic Domestic Violence

This case study follows a 7-year-old boy who presented with symptoms of posttraumatic stress disorder (PTSD) following exposure to domestic violence beginning at a very young age. During evaluation of this young boy’s symptoms, it became evident that his mother also was experiencing symptoms of PTSD. Consequently, treatment for both this young boy and his mother was proposed. Cognitive-behavioral therapy (CBT) has been used widely with both children and adults to treat PTSD. Fortunately, treatments have been tailored for young children (e.g., trauma-focused CBT [TF-CBT]; preschool PTSD treatment [PPT]) and for adults (e.g., cognitive processing therapy [CPT]). In the current case study, a combination of PPT and TF-CBT was utilized to treat this young boy, and CPT was utilized to treat his mother. With this course of treatment, this young boy demonstrated decreases in his PTSD symptoms and gained an understanding of coping skills and cognitive restructuring. His mother also demonstrated decreases in her PTSD symptoms. Overall, this dyad showed qualitative improvements in their general emotional and behavioral functioning, their individual self-regulation abilities, their social interactions, and their relationship. This case study provides evidence for the importance of treating both young child and parent when both have been exposed to and traumatized by domestic violence. Furthermore, this case study provides a framework for other health service providers to implement conjoint treatment of similarly traumatized families.

I’m Uncomfortable, You’re Uncomfortable, We’re Uncomfortable: An Integrative Family Approach to the Treatment of Tourette’s Disorder and Separation Anxiety Disorder in a Young Child

This case study follows a 6-year old Caucasian Hispanic male who presented with symptoms of Tourette’s disorder and separation anxiety disorder. Given the young age of the child, a critical focus was placed on parental involvement and parental mastery of the treatment components within an attachment-focused conceptualization as the foundation for all treatment delivery. To address all issues presented by the family of this young child, a behavioral treatment was utilized to target symptoms of Tourette’s disorder, and components of cognitive-behavioral therapy were used to address symptoms associated with separation anxiety disorder (in the young child). Further, components of an attachment-based parenting program, Circle of Security–Parenting, were inserted throughout treatment to keep this young child’s parents in tune with their relationship with their young child. Following completion of treatment, this young child displayed significant decreases in his symptoms across both disorders. Further, this young child and his parents demonstrated a mastery of treatment concepts and coping skills. The family reported both qualitative and quantitative improvements in the young child’s overall emotional and behavioral functioning. This study displayed the effectiveness of an integrative family-based approach in the treatment of a young child with symptoms of both Tourette’s disorder and separation anxiety disorder.

Beyond Reactive Attachment Disorder: How Might Attachment Research Inform Child Psychiatry Practice?

This article provides an updated review of attachment research with a focus on how comprehensive clinical assessment and intervention informs the care of young children. Child psychiatrists can serve as an important part of care coordination teams working with young children who have histories of early maltreatment and/or disruption in caregiving whether or not the children they are seeing meet criteria for an attachment disorder. Child psychiatrists should be familiar with both comprehensive assessment and the recent attachment-based interventions and appreciate how pharmacotherapy can be a useful adjunctive intervention when intensive therapy alone is ineffective.

Depression as a mediator in the relationship between perceived familial criticism and college adaptation

OBJECTIVE

This study examined relationships among emerging adults' perceived familial criticism, their depressive symptoms, and their college adaptation.

PARTICIPANTS

The current study examined the responses of 412 emerging adults (300 females and 112 males) who were college students at a large southeastern university. The majority of these emerging adults were Caucasian, but the remainder were from a broad range of racial backgrounds.

METHODS

Participants completed the Family Emotional Involvement and Criticism Scale as a measure of their familial criticism, the Student Adaptation to College Questionnaire as a measure of their college adaptation, and the Beck Depression Inventory-Second Edition as a measure of their depression.

RESULTS

Results were examined using correlational and regression analyses in the context of Baron and Kenny's (J Pers Soc Psychol. 1986;51:1173-1182) method for determining mediation. Results suggested that for female emerging adults, the relationship between perceived familial criticism and college adaptation was mediated significantly by depressive symptoms. In contrast, this pattern of results did not hold for male emerging adults.

CONCLUSIONS

Given these findings, emerging adults' depressive symptoms may serve as a useful proximal target for psychotherapeutic interventions meant to improve adaptation to college (particularly for female emerging adults), even in the context of high levels of perceived familial criticism from emerging adults' family of origin.

Mothers' Temperament and Personality: Their Relationship to Parenting Behaviors, Locus of Control, and Young Children's Functioning

There appears to be a lack of construct clarity and a dearth of studies that have examined both mothers' temperament and personality in conjunction with parenting behaviors when predicting young children's functioning. As a result, this study examined these constructs jointly so that a further understanding of how mothers' temperament and personality may work together to predict young children's functioning could be gained. As part of this study, 214 diverse mothers with young children who ranged in age from 2- to 6-years rated their own temperament and personality, their parenting characteristics, and their young children's functioning (i.e., temperament and emotional and behavioral functioning). Based on the findings of hierarchical regression analyses completed in this study, both mothers' temperament and personality may be important individual predictors of young children's temperament but may be important joint predictors, along with parenting behaviors, of young children's behavior problems. Consequently, future research should examine the role that mothers' temperament and personality characteristics may play in conjunction with their parenting behaviors when trying to understand young children's functioning. These findings will be particularly helpful for professionals providing parenting interventions to families with young children who have difficult temperament styles and/or emotional and behavioral problems.

Family-Based Cognitive–behavioral Therapy for an Intelligent, Elementary School-Aged Child With Generalized Anxiety Disorder

This case study follows an 8-year-old Caucasian female who presented with symptoms of Generalized Anxiety Disorder (GAD). Given this child’s age but advanced cognitive skills, careful selection of an appropriate treatment was made. In the current case study, a family-based cognitive–behavioral therapy intervention (Wood & McLeod, 2008) was implemented to treat this child’s symptoms of GAD. Following completion of the intervention, the child demonstrated significant decreases in her symptoms. In addition, she demonstrated a thorough understanding of coping skills, successfully applied and generalized her skills to a variety of situations, and took pride in teaching her skills to others. This child showed quantitative improvements on objective self-report measures as well as qualitative improvements in her overall emotional and behavioral functioning. This case study suggested that cognitive–behavioral therapy interventions, particularly when used in a family-based approach, are effective for children with symptoms of GAD.

The state of evidence-based parenting interventions for parents who are substance-involved

Approximately 70 million children and adolescents live with at least one parent who abuses or is dependent on alcohol or an illicit substance. Given the negative parenting practices that substance-involved mothers and fathers tend to exhibit as well as the poor outcomes that their children, particularly their young children, experience, evidence-based parenting interventions are an important complement to substance abuse treatments. At this time, there are few studies that compare the efficacy of parenting interventions for these parents, however. Nonetheless, research has begun to examine skill-based and attachment-based parenting interventions for substance-involved families with young children. These parenting interventions should be considered within the context of the neurobiology of substance abuse, which emphasizes the role of dopamine in the reward systems that promote substance use. In the context of these neurobiological connections, parenting interventions that engender repeated intense emotional experiences may stimulate this same reward system and, therefore, may be more efficacious. Attachment-based interventions are particularly promising when such connections are considered. More attention needs to be paid to bringing impactful parenting interventions to substance-involved parents with young children.

Preschool PTSD Treatment (PPT) for a Young Child Exposed to Trauma in the Middle East

This case study follows a 5-year-old biracial boy who presented with symptoms of post-traumatic stress disorder (PTSD), separation anxiety, and oppositionality. Cognitive-behavioral therapy (CBT) has been used widely with children to treat a number of anxiety disorders, including PTSD, with success. In the current study, Preschool PTSD Treatment (PPT) was used to treat the symptoms of PTSD in this young boy. After PPT treatment was implemented, he demonstrated significant decreases in his post-traumatic stress symptoms and in his symptoms of separation anxiety and oppositional behavior. In addition, he demonstrated an understanding of and the ability to apply coping and problem-solving skills. Finally, this young boy showed qualitative improvements in academic performance, social interactions, and general emotional and behavioral functioning. This case study added to the growing literature highlighting the utility of using CBT to successfully treat symptoms of PTSD in young children.

Relationships among parents' economic stress, parenting, and young children's behavior problems

In a time of economic recession, identifying how economic stress may be related to parenting stress, to the parenting behaviors used by mothers and fathers, and to young children's behavior problems may provide insight into interventions that may best assist families through their own economic crises. As part of this study, 124 culturally diverse parents with young children who ranged in age from 2- to 6-years rated their own economic, life, and parenting stress; their parenting behaviors; and their young children's behavior problems. Hierarchical regression analyses suggested that negative economic events and parenting stress provide unique incremental variance in predicting young children's internalizing problems, whereas life stress and parenting stress provide unique incremental variance in predicting young children's externalizing problems. With closer examination, parenting stress fully mediated the relationship between parents' financial cutbacks and young children's internalizing problems and the relationship between parents' negative economic events and young children's externalizing problems. These findings suggested that these variables are important to examine collectively.

The role of attachment in the relationship between child maltreatment and later emotional and behavioral functioning

The experience of childhood maltreatment is an important predictor of unfavorable emotional and behavioral outcomes. Because little research examined explanatory variables in the relationship between childhood maltreatment experiences and later outcomes, this study examined the role that attachment serves in this relationship. Four hundred twenty-four participants completed questionnaires assessing the variables of interest for this study. Results indicated that both childhood maltreatment experiences (particularly emotional abuse) and attachment (particularly to mothers and peers) are significant predictors of later emotional and behavioral outcomes. Further, attachment contributed unique and significant variance to the relationship between childhood maltreatment experiences and later outcomes. Such findings suggested that secure attachment may serve as a protective factor against maladaptive emotional and behavioral outcomes as children reach emerging adulthood, even in the context of childhood maltreatment experiences. The importance of studying the relationships among these variables is discussed.

Bipolar disorder in children

Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.

Perceived stress, external locus of control, and social support as predictors of psychological adjustment among female inmates with or without a history of sexual abuse

Given the growing number of women who are incarcerated across the United States, the current study investigated the relationships among female inmates' perceptions of their own stress, external locus of control (LOC), social support adequacy, and various aspects of psychological functioning. Generally, female inmates with a self-reported history of childhood sexual abuse did not differ from their nonabused counterparts on the variables of interest. Results suggested that female inmates' perceptions of higher stress, a higher degree of external LOC, and inadequate social support correlated with greater symptoms of depression and hopelessness as well as lower self-esteem. In regression analyses, stress and social support were significant predictors for depression and anxiety. In contrast, stress was the only significant predictor of hopelessness and self-esteem. Finally, none of the predictors examined here was significant in the prediction of traumatic stress. Overall, findings suggested the importance of stress and social support in the prediction of female inmates' adjustment, specifically their symptoms of depression and anxiety.

Emerging adults' stress and health: the role of parent behaviors and cognitions

Although parent behaviors and cognitions are important for stress/health outcomes throughout development, little research examines whether cognitions mediate the relationship between parent behaviors and stress/health outcomes. As a result, the current study examined the reports of 160 emerging adults regarding their mothers' and fathers' behaviors (via the Parental Bonding Instrument and Alabama Parenting Questionnaire), their cognitions (via the Stress Appraisal Measure, Negative Mood Regulation Scale, Life Orientation Test-Revised, General Self-Efficacy Scale, and Ruminative Response Scale-Abbreviated), and their stress/health outcomes (via the Perceived Stress Scale and Short-Form Health Survey). Results of this study suggested that emerging adults' cognitions partially mediated the relationship between their mothers' behaviors and their stress/health outcomes and fully mediated the relationship between their fathers' behaviors and their stress/health outcomes. Future research should examine parent behaviors as important distal variables in emerging adults' stress/health outcomes but should examine cognitions as more salient, immediate predictors of their stress/health outcomes.

Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

A multivariate model of parent-adolescent relationship variables in early adolescence

Given the importance of predicting outcomes for early adolescents, this study examines a multivariate model of parent-adolescent relationship variables, including parenting, family environment, and conflict. Participants, who completed measures assessing these variables, included 710 culturally diverse 11-14-year-olds who were attending a middle school in a Southeastern state. The parents of a subset of these adolescents (i.e., 487 mother-father pairs) participated in this study as well. Correlational analyses indicate that authoritative and authoritarian parenting, family cohesion and adaptability, and conflict are significant predictors of early adolescents' internalizing and externalizing problems. Structural equation modeling analyses indicate that fathers' parenting may not predict directly externalizing problems in male and female adolescents but instead may act through conflict. More direct relationships exist when examining mothers' parenting. The impact of parenting, family environment, and conflict on early adolescents' internalizing and externalizing problems and the importance of both gender and cross-informant ratings are emphasized.

The relationship between parents' and children's automatic thoughts in a college student sample

Research demonstrates the importance of early social interactions in the development of schemas and automatic thoughts. It does not appear, however, that the existing research examines intergenerational correlations in automatic thoughts. As a result, this study explores the relationship between the automatic thoughts of parents and those of their college-age children in a sample of 252 college students and their mothers and fathers. Results of this study suggest that there are significant relationships between parents' and college students' positive automatic thoughts. Different trends by gender also are noted in the relationships among variables for male and female college students with their mothers and fathers. Further, mothers' positive ATs predicted the positive ATs of their college students, with mothers' ratings of their own communication with their college students mediating partially this relationship. Finally, college students' anxiety and self-esteem is predicted significantly by their mothers' anxiety and self-esteem (respectively) as well as their own positive and negative ATs. These findings suggest the possibility that ATs play a role in the intergenerational transmission of certain domains of psychological functioning.

Undergraduate students' attributions of depicted adult-adolescent and adolescent-adolescent sexual interactions

The grayest areas of defining child sexual abuse appear to involve the age and sex of the individuals involved, resulting in a potential for different attributions regarding child sexual abuse across individuals. As a result, this study examines the responses of 262 male and female college student participants after viewing a series of hypothetical sexual abuse vignettes that depicted a 15-year-old victim that neither resisted nor encouraged the advances of a 15-, 25-, or 35-year-old perpetrator's actions. Gender roles and sexual attitudes were examined as potentially important covariates. Using a series of analyses of covariance, female participants gave more pro-victim ratings than male participants, and younger perpetrators were viewed less negatively than older perpetrators. Gender roles and sexual attitudes served as significant covariates. These findings emphasized the need to educate individuals about child sexual abuse and unwanted sexual contact involving individuals under the age of consent.

Differential relationship of recent self-reported stress and acute anxiety with divided attention performance

There have been relatively few studies on the relationship between recent perceived environmental stress and cognitive performance, and the existing studies do not control for state anxiety during the cognitive testing. The current study addressed this need by examining recent self-reported environmental stress and divided attention performance, while controlling for state anxiety. Fifty-four university undergraduates who self-reported a wide range of perceived recent stress (10-item perceived stress scale) completed both single and dual (simultaneous auditory and visual stimuli) continuous performance tests. Partial correlation analysis showed a statistically significant positive correlation between perceived stress and the auditory omission errors from the dual condition, after controlling for state anxiety and auditory omission errors from the single condition (r = 0.41). This suggests that increased environmental stress relates to decreased divided attention performance in auditory vigilance. In contrast, an increase in state anxiety (controlling for perceived stress) was related to a decrease in auditory omission errors from the dual condition (r = - 0.37), which suggests that state anxiety may improve divided attention performance. Results suggest that further examination of the neurobiological consequences of environmental stress on divided attention and other executive functioning tasks is needed.

Multivariate models of parent-late adolescent gender dyads: the importance of parenting processes in predicting adjustment

Although parent-adolescent interactions have been examined, relevant variables have not been integrated into a multivariate model. As a result, this study examined a multivariate model of parent-late adolescent gender dyads in an attempt to capture important predictors in late adolescents' important and unique transition to adulthood. The sample for this study consisted of 151 male and 324 female late adolescents, who reported on their mothers' and fathers' parenting style, their family environment, their mothers' and fathers' expectations for them, the conflict that they experience with their mothers and fathers, and their own adjustment. Overall, the variables had significant relationships with one another. Further, the male-father, male-mother, and female-father structural equation models that were examined suggested that parenting style has an indirect relationship with late adolescents' adjustment through characteristics of the family environment and the conflict that is experienced in families; such findings were not evident for the female-mother model. Thus, the examination of parent-late adolescent interactions should occur in the context of the gender of parents and their late adolescents.

Perceived Parenting, Positive and Negative Perceptions of Parents, and Late Adolescent Emotional Adjustment

Many studies have established that warm, authoritative parenting is associated with positive adjustment in children and adolescents. Fewer studies, however, have examined the potential mechanisms driving this relationship. The current study explores the effects of late adolescents' positive and negative perceptions of their parents in the association between perceived parenting and late adolescent emotional adjustment (depression, anxiety, and self-esteem). The sample consisted of 151 males and 324 females ranging in age from 18- to 22-years. Data were analysed with structural equation modeling. Results of the study suggested that perceived parenting, positive and negative perceptions of parents, and emotional adjustment as reported by late adolescents all are correlated significantly. The effects of perceived parenting on late adolescents' emotional adjustment, however, were not statistically significant when analysed simultaneously with late adolescents' positive and negative perceptions of parents. Also, the relationship between late adolescents' positive and negative perceptions of parents and late adolescent emotional adjustment became non-significant when examining father relationships. Overall, the importance of considering parenting in the context of parent and adolescents' sex as well as other variables is emphasised.

Interpretation of teasing during early adolescence

Research has suggested that teasing, especially about physical appearance, is a common experience with negative consequences for adolescents. This study aimed to examine the cognitive processes of adolescents exposed to teasing. Students from two middle schools were assigned randomly to view videotaped vignettes of appearance-related teasing, competency teasing, or a control situation and completed questionnaires to assess their cognitive reactions and memories of the teasing. Results indicated that adolescent girls recalled appearance-related teasing more readily than competency teasing, adolescent girls with high body dissatisfaction recalled fewer positive appearance words, and participants exposed to competency teasing were more likely to recall competency words. The findings indicated that cognitive processes may be important in the study of adolescents' interpretation of teasing and for clinical treatment of adolescents who are teased.

Childhood discipline, perceptions of parents, and current functioning in female college students

This study examined the relationships among the childhood discipline styles experienced by 116 female college students, their perceptions of their parents, and their current functioning. Results of this study indicated that female college students' report of childhood discipline, their perceptions of their parents, and their outcomes were related uniquely when examining responses for mothers and fathers. Further, regression analyses suggested that negative perceptions of mothers may mediate the relationship between maternal psychologically assaultive discipline and female college students' depression and self-esteem and mediate partially the relationship between maternal psychologically and physically assaultive discipline and female college students' anxiety. In contrast, fathers' use of psychologically assaultive discipline and female college students' positive and negative perceptions of their fathers predicted depression, whereas only their perceptions predicted anxiety and self-esteem. These results suggested the importance of examining discipline and perceptions of parents when examining the functioning of late adolescents and emerging adults.

Freshmen adaptation to university life: Depressive symptoms, stress, and coping

Attending a university for the first time can be a stressful experience for many new college students. This study examines the relationships among femininity and masculinity, depressive symptomatology, levels of stress, and the types of coping strategies used by college freshmen. Results of this study suggest that these variables were related uniquely for first-year college students. Masculinity and femininity significantly predicted problem-focused coping, and femininity significantly predicted emotion-focused coping. Further, the levels of family and college stress reported by college students, as well as their endorsement of avoidant coping, significantly predicted their levels of depressive symptoms. Overall, the results of this study suggest that understanding the relationships among the gender role, the levels of depressive symptomatology, and the levels of stress exhibited by college freshmen may be important in facilitating their transition and adjustment to university life.

Retrospective reports of college students' childhood problems

College students and a subsample of their mothers and fathers participated in a study examining their retrospective reports of childhood emotional and behavioral problems experienced by college students. College students and their mothers and fathers exhibited moderate correspondence in their recollection of internalizing and externalizing problems that college students experienced during their childhood. In contrast, college students tended to endorse significantly greater levels of both internalizing and externalizing problems relative to their mothers and fathers. Current psychological symptoms predicted the greater endorsement of childhood internalizing and externalizing problems by college students and the greater endorsement of college students' childhood internalizing problems by their mothers. Further, college students' current perceptions of their parents predicted their endorsement of childhood internalizing problems, and college students' current masculinity and femininity predicted their endorsement of childhood externalizing problems. Results of this study emphasized the importance of noting factors that may be related to retrospective reports.

The effects and treatment of community violence in children and adolescents: what should be done?

The amount of community violence that children and adolescents are exposed to is unsettling. Intensifying the issue, the amount of community violence that is wit-nessed or experienced directly by children and adolescents is increasing with time. It has been documented that children and adolescents who are exposed to community violence display a wide array of psychological symptoms, ranging from depression and anxiety to antisocial and suicidal behaviors. Many variables have been studied in an attempt to determine correlates, moderators, and mediators of exposure to community violence. Furthermore, many intervention strategies have been developed from the discovery of relationships among these variables. Despite these efforts, many children continue to suffer from the negative effects of exposure to community violence. The purpose of this article is to encourage mental health professionals to mobilize their efforts to help children, adolescents, and their families cope with the effects of community violence.

Cross-informant ratings of social competence in children and adolescents

The cross-informant ratings of social competence displayed by children and adolescents were investigated in a meta-analytic study. Effect sizes from 74 studies containing the ratings of the social competence of children and adolescents from at least two different informants were included in this meta-analysis. Results indicated that studies investigating the correspondence of the child or adolescent's own report with the report of parent, teacher, or peer informants had average effect sizes that were small in magnitude. The average effect sizes of other types of cross-informant pairs (e.g., parent-teacher) were moderate in magnitude, with teachers and peers demonstrating the greatest correspondence. Potential moderators (e.g., the type of measure completed by the informants, the age and gender of the target child or adolescent, and the location of the assessment) were also examined. These results demonstrate the importance of selecting carefully informants when evaluating the social competence of children and adolescents.

The relationship of gender, gender identity, and coping strategies in late adolescents

The relationships among gender, gender identity, and coping in late adolescents were examined. One hundred sixty-nine late adolescents completed measures assessing their masculinity and femininity, as well as their use of coping strategies. Females endorsed greater use of emotion-focused coping strategies than males. Late adolescents who were high in masculinity endorsed higher levels of problem-focused coping strategies than those who were low in masculinity. In contrast, late adolescents who were high in femininity endorsed higher levels of emotion-focused coping strategies than those who were low in femininity. Neither the gender nor the masculinity and femininity of late adolescents were predictive of the use of avoidant coping strategies. Overall, gender identity made an important and independent contribution to the endorsement of coping strategy use. These results emphasize the importance of assessing both gender and gender identity with regard to coping in late adolescents.

Reasons for therapy termination in a university psychology clinic

This study examined the reasons for therapy termination documented by graduate student therapists. The closed case files of individual adult clients who had terminated their therapy experience at a university-based psychology clinic were reviewed. Results indicated that the most frequent reasons for termination documented by graduate student therapists were that clients stopped attending therapy sessions without providing their therapists with notice or reason and that clients reached a satisfactory termination point in their therapy experience. A substantial number of clients terminated therapy because of difficulties unrelated to therapy, seeking services elsewhere, or dissatisfaction with therapy services. Level of depressive symptomatology and the number of sessions attended differed across clients who had different reasons for termination. By addressing such client concerns early in the therapy experience, premature termination may be prevented.

Predicting therapy duration from therapist experience and client psychopathology

This study examined the relationships among therapist experience, the cost of therapy services, the degree of client psychopathology, and the number of therapy sessions clients attended following intake. The closed files of 407 clients at a university-based psychology outpatient clinic were examined. Results indicated that the duration of therapy was predicted from the experience of the graduate-student therapist, with higher levels of therapist experience predicting fewer therapy sessions. Although measures of client psychopathology did not directly predict therapy duration, therapist experience became only a marginally significant predictor when client psychopathology was allowed to act as a covariate. Fees paid for therapy did not predict therapy duration. These findings emphasize the importance of accounting for therapist and client characteristics when examining client attendance in therapy.

The therapeutic efficacy and cost-effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes

We conducted a randomized trial comparing bed rest with tocolysis to determine the therapeutic efficacy, safety, and cost-effectiveness of tocolysis for the treatment of preterm labor after membrane rupture. One hundred nine women participated over a 26-month interval. Treatment groups did not differ significantly in terms of gestational age at membrane rupture, gestational age at delivery, birth weight, maternal or fetal infectious morbidity, respiratory distress syndrome, necrotizing enterocolitis, or perinatal mortality. Prolongation of intrauterine time after the onset of uterine contractions was seen in women receiving tocolysis (105.2 +/- 157 hours versus 62.1 +/- 77 hours, p = 0.06). This prolongation was not associated with a significant reduction in the total cost per surviving infant (tocolysis, $38,593 +/- $40,887 versus bed rest, $43,158 +/- $37,116; p = 0.445). The cost difference was artifactual. The number of very premature infants born (less than 28 weeks' gestation) was unequal in the two groups (12 in the bed rest group and 5 in the tocolysis group) and skewed the results. Before 28 weeks' gestation tocolysis was associated with a significant increase in intrauterine time after the onset of regular contractions (p = 0.05). However, there was no identifiable perinatal benefit garnered from the additional 5 days. After 28 weeks there were no significant differences between treatment groups in terms of intrauterine time after the onset of regular contractions and total cost per surviving infant. Because tocolysis does not improve perinatal outcome and can itself be associated with major maternal morbidity, it should be avoided after 28 weeks' gestation. Before 28 weeks' gestation tocolysis may greatly increase intrauterine time, but the benefit of this prolongation is not clear.