Family Intervention to Prevent Depression and Substance Use Among Adolescents of Depressed Parents

Parental depression places offspring at elevated risk for multiple, co-occurring problems. The purpose of this study was to develop and preliminarily evaluate Project Hope, a family intervention for the prevention of both depression and substance use among adolescent-aged children (M?=?13.9?years) of depressed parents. The program was created by blending two empirically supported interventions: one for depression and another for substance use. Thirty families were randomly assigned to either Project Hope (n?=?16) or a wait-list control condition (n?=?14). Pretests, posttests (n?=?29), and 5-month follow-ups (n?=?28) were conducted separately with parents and youth via phone interviews. Questions asked about the family depression experience, family interactions, family management, coping, adolescent substance use beliefs and refusal skills, adolescent depression, and adolescent substance use. Project Hope was fully developed, manualized, and implemented with a small sample of targeted families. Engagement in the program was relatively high. Preliminary outcome analyses were conducted using 2 (Group) ×3 (Time) analyses of covariance. Results provided some evidence for significant improvements among intervention compared to control participants in indicators of the family depression experience, family management, and coping, and a statistically significant decrease from pretest to posttest in alcohol quantity for intervention compared to control youth. Next steps for this program of research are discussed.     

The Structure of Family Perceptions Among Adolescents and Their Parents: Individual Satisfaction Factors and Family System Factors

This study examined the underlying structure of self-reports of family functioning by adolescents, mothers, and fathers (N of individuals = 360) from intact families. Participants completed a multidimensional self-report measure of family functioning, and their responses were entered into a factor analysis with the family as the unit of analysis (N of cases = 120). The results indicate two types of factors: individual satisfaction factors and family system factors. The findings are consistent with the view that different types of characteristics assessed in self-report measures of the family may be stored as different kinds of memories. The findings also provide preliminary data toward understanding the linkages between family system factors and satisfaction with the family based on family roles as adolescents, mothers, and fathers.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents’ experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7–30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219–252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.     

Scene-Based Psychodramatic Family Therapy With Troubled Adolescents and Parents: A Pilot Study

Scene-Based Psychodramatic Family Therapy (SB-PFT) is an innovative treatment used with troubled adolescents and their parents to improve family relationships and reduce adolescents’ problematic behavior. It integrates the principles of family therapy, psychodrama, and multiple-family group methodology. This research is a pilot study to obtain empirical evidence on the SB-PFT therapeutic process by gauging the perception of change of troubled adolescents and their parents, and assess the perceived helpfulness of its methodology and techniques. Ten multiple-family intervention groups were drawn up, with 110 participants (63 adolescents and 47 parents), and we adopted a qualitative methodology with focus groups, using an inductive analysis of 290 active constructions of participant narratives. Concerning perception of change, the adolescents reported mainly gaining in social support, prosocial attitudes, keys to problem solving, and expression of emotions due to the treatment. The parents perceived improvement in social support, keys for educational practices, emotional well-being, and expression of emotions due to the treatment. Regarding the perceived helpfulness of methodology and techniques, both adolescents and parents highlighted the usefulness of the group methodology for gaining social support, relativizing the problem, and expressing emotions. Additionally, participants referred to role-playing and mirror techniques as the most useful techniques. In conclusion, this first study on SB-PFT presents and describes its treatment for troubled adolescents and their parents. The participants’ positive perception of their personal and relational change after treatment should serve to promote further studies with quantitative methodology in order to verify the effectiveness of SB-PFT treatment.     

The Emotion Regulation Strategies of Adolescents and their Parents: An Experience Sampling Study

Parents are the main socialization agents in the development of emotion regulation (ER). In this study, we evaluated adolescents’ and their respective parents’ perspectives about their use of two ER strategies (cognitive reappraisal and expressive suppression) in daily life. In addition, we evaluated the within-family associations between adolescents’ and their parents’ use of strategies. We controlled for adolescents’ gender and age and the perceived quality of their relationships with their parents (mothers and fathers). The sample consisted of 33 12- to 18-year-old adolescent–father–mother triads, totaling 99 participants. Parents and adolescents reported their use of ER strategies in response to eight random prompts throughout the day, by means of the experience sampling method for 1 week. Participants provided 4082 reports on their momentary experiences. The data were analyzed using multilevel modeling to account for the hierarchical structure of the repeated daily assessments. The significant association between parents’ and adolescents’ use of ER strategies was specific to mother–adolescent dyads. The significant association between adolescents’ and their mothers’ ER strategies varied as a function of the adolescents’ age and the quality of their relationship with their mothers according to adolescents’ reports, but not as a function of adolescent gender. These findings suggest that mothers have a role in their adolescents’ emotion regulation in a developmental period characterized by autonomy from parental guidance.     

Inconsistent Self-Report of Delinquency by Adolescents and Young Adults with ADHD

The purpose of the current study was to test the ability of adolescents and young adults with childhood ADHD to reliably self-report delinquency history. Data were examined from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of children diagnosed with ADHD between 1987 and 1996. Self-report of lifetime delinquency history was compared to concurrent parent-report and to self-report 1 year later. Participants included 313 male probands and 209 demographically similar comparison individuals without ADHD. Results indicated that adolescents and young adults with childhood ADHD were more likely than comparison participants to fail to report delinquent acts reported by a parent and to recant acts they endorsed 1 year earlier. This trend was most apparent for acts of mild to moderate severity. After controlling for several covariates, current ADHD symptom severity and parent-report of the participant’s tendency to lie predicted reporting fewer delinquent acts than one’s parent. Current ADHD symptom severity also predicted more recanting of previously endorsed acts. Based on these findings, several recommendations are made for the assessment of delinquency history in adolescents and young adults with childhood ADHD.     

Cognitive Functioning in Adolescents with Self-Reported ADHD and Depression: Results from a Population-Based Study

This study aims to assess cognitive functioning differences among adolescents with retrospectively self-reported: ADHD and an onset of depression, only ADHD, only depression, and neither ADHD nor depression. Data from the Tracking Adolescents’ Individual Lives Survey (TRAILS) cohort was used in this study. Neuropsychological functioning was assessed in 1549 adolescents, at baseline and follow-up (mean ages 11 and 19 years). The Composite International Diagnostic Interview was used to classify adolescents into 4 groups: ADHD with onset of depression, only ADHD, only depression, and neither ADHD nor depression. Linear mixed effects models were used to analyse group differences in cognitive functioning at baseline and follow-up, and the change in cognitive functioning between these 2 time-points. Results showed a significant main effect of group on response time variability at baseline, working memory maintenance at follow up, and change in response time variability scores between baseline and follow-up. As compared to the healthy and depressed-only groups, adolescents with only ADHD showed longer response time variability at baseline and, which declined between baseline and follow-up. Adolescents with ADHD plus depression showed higher reaction time for working memory maintenance than the depressed only and healthy groups at follow-up. In conclusion, adolescents with self-reported ADHD show poorer cognitive functioning than healthy adolescents and those with only depression. Amongst adolescents with ADHD, specific cognitive domains show poor functioning depending on the presence or absence of comorbid depression. While adolescents with only ADHD have lower reaction time variability, those with comorbid depression have poorer working memory maintenance.     

学校氛围与青少年学校适应：一项追踪研究

通过对709名青少年进行追踪研究,分别以青少年自我报告与教师评价的方式测查了学校氛围与学校适应,主要探讨学校氛围与青少年学校适应的长期预测关系,以及性别在二者间的调节效应.结果表明:(1)青少年第一年感知到的学校氛围能预测其第二年、第三年的适应问题和适应能力,第二年感知到的学校氛围能预测其第三年的适应能力和学业成绩;(2)青少年感知到的自主机会对其学校适应有负面作用;(3)教师支持和同学支持对青少年学校适应具有积极作用,但同学支持的作用会随着在校时间的增加而发生逆转,即第一年的同学支持负向预测第二年的学习问题和第三年的学业成绩,正向预测第三年的适应能力,而第二年的同学支持则对第三年的适应能力和学业成绩均有负向预测作用;(4)女生的学校适应普遍好于男生,性别对学校氛围与青少年学校适应之间的关系具有部分调节作用.     

Perceptions of Singles and Single Parents: A Laboratory Experiment1

Two hundred forty undergraduates rated their perceptions of an individual for a job requiring relocation using a 2 × 3 (Gender: Single Male, Single Female × Child: No Child, 3‐Year‐Old, 6‐Year‐Old) between‐subjects experimental design. Findings indicate that single parents are perceived as having a more difficult time adjusting to a move but are also perceived to be more mature than childless singles. Single parents are also more likely to be offered a job that did not require relocation and are more likely to be awarded a merit‐based stipend than childless singles. Support was also found for the hypothesized mediating role of perceptions of adjustment and maturity in understanding actions taken toward single parents. The results are discussed in terms of implications for future research and applied practice.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

The Relationship Between Perceptions of Neighborhood Characteristics and Substance Use Among Urban African American Adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.     

Research to Practice: Implementation of Family School Success for Parents of Children With ADHD

“Family-School Success” (FSS) is an efficacious intervention improving the home and school functioning of children with ADHD in grades 2–6. An extension of this intervention designed for a younger population also showed positive effects for kindergarten and first grade students in a pilot study. Following the completion of these trials, FSS was implemented in a fee-for-service tertiary care ADHD center. The implementation process included adapting the manual and treatment procedures to be feasible outside the structure and support of a federally funded randomized control trial (RCT). The current study examines the process of adapting the treatment protocol and examines the acceptability and effectiveness of the adapted FSS, as well as predictors of family treatment response including parent engagement in treatment (as measured by attendance and homework adherence). A case study illustrates the adaptations to the intervention and its implementation in the clinic-based setting. In line with findings from clinical trials, families reported high satisfaction with the adapted FSS intervention and showed significant improvement in parental self-efficacy, child academic homework performance, and reduction in child impairment. Additionally, as in the initial FSS RCT, parental attendance in the adapted FSS program predicted child attention to academic homework, controlling for parental adherence to between-session homework. Furthermore, controlling for attendance at FSS sessions, parent adherence to between-session homework assignments predicted improvements in parent self-efficacy as well as child’s homework productivity. These results replicate those of the original RCT and confirm that both session attendance and between-session homework completed are important for improvement during the program. Overall, this study provides support for the acceptability and effectiveness of this treatment model and suggests that future work toward dissemination to community-based settings would be worthwhile.     

Gender and Acculturation in Relation to Traditionalism: Perceptions of Self and Parents Among Chinese Students

The acculturation attitudes and traditionalismof Chinese university students in Toronto, Canada, wereinvestigated. Chinese men were significantly moretraditional than Chinese women in their beliefs and expectations regarding family hierarchy and thesocial roles of women and men, but they did not differin perceptions of their parents' construal of familyrelations and gender roles. Generational discrepancy between self and perceived parental values wasfound for Chinese women but not for men in the study,suggesting greater conflict with regard to traditionalgender role and cultural values for women. The acculturation attitude of separation predictedstudents' traditionalism, and marginalization predictedparents' perceived traditionalism. Gender differencesand the relevance of different modes of acculturation with regard to traditionalism are discussed inthis article.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

Medical Students' Perceptions of and Willingness to Treat Patients Who Are HIV Infected1

The purpose of this study is to examine the independent and joint influences of a patient's mode of acquisition of illness (blood transfusion vs. multiple sexual partners), attributions of responsibility (self-blame vs. chance blame), and sexual orientation (homosexual vs. heterosexual) on female and male medical students' attitudes toward and willingness to treat a patient who is HIV infected. One hundred nineteen 1st through internship-year medical students were randomly assigned to read and respond to case vignettes. Greater consistency between attribution of blame and mode of acquisition was related to more positive perceptions. Furthermore, the patient's sexual orientation influenced the providers' willingness to offer treatment, particularly for male medical students. Implications concerning health practices and medical education are considered.     

Concurrent Treatment of Depression in Parents and Adolescents: A Case Example

The detrimental influence of parent psychopathology—and depression, in particular—on adolescent mental health has been well documented. Routes of transmission include both direct and indirect factors, such as poor parent–adolescent communication, ineffective parenting practices, modeling ineffective coping skills, increased family discord and stress, inadvertent reinforcement of adolescent depressed mood and suicidal ideation and behavior, and decreased treatment adherence. This paper introduces a novel treatment to concurrently treat both a depressed adolescent as well as a depressed parent. This approach improves upon traditional cognitive-behavioral therapy by targeting relational factors of each adolescent–parent dyad while simultaneously addressing each individual’s depression. Principles of case conceptualization and treatment planning using this novel approach are illustrated using a case example.