Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.     

The Children's Firesetting Interview with psychiatrically referred and nonreferred children

This study evaluated the Children's Firesetting Interview (CFI). The measure was developed to operationalize multiple domains of functioning derived from a riskfactor model of firesetting. The model poses that child, parent, and family characteristics promote firesetting and continuation of a pattern of firesetting. Major factors include curiosity about fire, involvement in and exposure to firerelated activities, and knowledge about first safety The CFI, consisting of 46 questions reflecting six a prioridimensions, was administered to 519 children (ages 6–13) recruited from nonpatient, outpatient, and inpatient samples. Internal consistency and testretest reliability of the measure were satisfactory. Criterion validity was supported by the findings that firesetters showed greater curiosity about fire, involvement in firerelated activities, exposure to models/materials, and knowledge about things that burn than did nonfiresetters. These findings did not vary as a function of the child's patient status or level of antisocial behavior. Implications for the evaluation of firesetting risk are discussed.This study was supported by grant MH-39976 from the Antisocial and Violent Behavior Branch of the National Institute of Mental Health and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors acknowledge the constructive suggestions of two anonymous reviewers.     

Identifying depression in children: A comparison of alternative selection criteria

This study evaluated commonly used methods of identifying depressed children and examined the extent to which the conclusions about correlates of dysfunction vary among different selection criteria. Child psychiatric patients (N=237,ages 7–12) and their parents participated and completed measures to permit identification of depressed children on the basis of three separate criteria, including selfreport scores on the Children's Depression Inventory, parent-reported scores for the same measure, and a DSM-III diagnosis of major depression. The study examined whether depressed and nondepressed children, defined separately by the different criteria, differed in a variety of depression-related symptoms, cognitive processes, and social activity. The results indicated little overlap in the persons identified as depressed on the basis of child-or parent-completed CDI scores or DSM-III diagnosis. Depressed and nondepressed children tended to differ across all domains (depression-related symptoms, cognitive processes, and social activity) for each selection criterion. However, significant differences were evident in these domains only when the selection criterion and other domains were assessed with the same informant (e.g., self-report) and hence shared a common method (rater) component. The findings underscore the potential influence that method factors may have in influencing the conclusions that are drawn regarding the correlates of childhood depression.Completion of this research was supported by a Research Scientist Development Award (MH00353) and by a grant (MH35408) from the National Institute of Mental Health. The author is grateful to Debra Bass, Antoinette Rodgers, and Todd Siegel for assistance with this project.     

Developmental psychopathology. Current research, issues, and directions

Developmental psychopathology refers to the study of clinical dysfunction in the context of maturational and developmental processes. Although the field encompasses the entire life span, the present focus is on childhood. Special characteristics make the study of childhood dysfunction somewhat unique, including the emergence, evolution, and attenuation of seemingly problematic behaviors over the course of development; the manner in which children are referred for clinical evaluation; and complexities in identifying the appropriate foci for clinical intervention. Notwithstanding these obstacles, recent work has advanced considerably in diagnosis, assessment, and treatment of childhood disorders. The present article highlights recent advances in these areas and promising extensions in current research. Many advances have relied heavily on the extension of paradigms developed in research with adults. Additional research is needed that draws on and integrates conceptual and empirical work from developmental psychology.     

Behavioral assessment of methylphenidate in a child with frontal lobe damage

The assessment and management of inattentive, hyperactive, and impulsive behavior in a 6-year-old girl who experienced frontal lobe damage are described. A multimodel approach combining medical, educational, and behavioral techniques to assess hyperactive behavior, optimal medication level, and medication and psychotherapeutic effectiveness is described. The results of the study suggest that in similar cases, children and adolescents manifesting these behaviors should be given a trial of stimulant medication in a controlled environment to assess if such therapy is indicated. Additional support is given for the increasing need for detanté and cooperation with health-care professionals.     

The interview for antisocial behavior: Psychometric characteristics and concurrent validity with child psychiatric inpatients

The present study evaluated psychometric features and correlates of the Interview for Antisocial Behavior (IAB), a new measure designed to assess antisocial child behavior. Parents of 264 psychiatric inpatients (ages 6–13 years) completed the measure to evaluate antisocial behavior of their children. The investigation evaluated the relation of IAB scores to clinically derived diagnoses and to aggression and externalizing behaviors, as measured by different raters (parents, teachers), across different settings (home, school, hospital), and with different assessment methods (rating scales, behavioral role-play test). The results indicated that the IAB showed acceptable levels of internal consistency. A priori scores (severity, duration, total antisocial behavior) and factor analytically derived scales (Arguing/Fighting, Covert Antisocial Behaviors, Self-Injury) distinguished children with a DSM III diagnosis of conduct disorder, and scores on the IAB were more consistently related to other measures of aggression and externalizing behavior than to measures of internalizing behavior or overall severity of dysfunction. The implications of the results for use of the measure, particularly in relation to evaluation of the overt-covert dimension of antisocial behavior, are discussed.Completion of this research was facilitated by a Research Scientist Development Award (MH00353) and by grants (MH35408, MH39642) from the National Institute of Mental Health and the Rivendell Foundation.     

Covert and overt rehearsal and elaboration during treatment in the development of assertive behavior

The present investigation examined the effects of covert and overt rehearsal and client elaboration of situations designed to train assertive behavior. Nonassertive clients (n = 61) received one of four treatments resulting from the 2 × 2 factorial combination of Modality of Rehearsal (covert vs overt) and Elaboration (elaboration vs no elaboration of training situations). A delayed-treatment group was included in the design to serve as a no-treatment control condition before subjects were assigned randomly to one of the above treatments. Treatment led to significant improvements on self-report and behavioral measures of assertiveness and self-efficacy. Covert and overt rehearsal were equally effective. However, elaboration of training situations significantly enhanced the effects of covert and overt rehearsal. Treatment effects were maintained up to a 6-month follow-up, transferred to novel role-playing situations, and brought clients within the range of other subjects (n = 45) who regarded themselves as adept in social situations requiring assertive behavior and who had not sought treatment.     

ACCEPTABILITY OF ALTERNATIVE TREATMENTS FOR DEVIANT CHILD BEHAVIOR

The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were applied to children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance.