Parent and Teacher Agreement of Behavior Problems in Youth Diagnosed With and Without Autism Spectrum Disorders

The prevalence and severity of behavioral problems in youth with autism spectrum disorders (ASD) may be context dependent leading to discrepant informants’ reports and complicating case conceptualizations and treatment goals. This study examines the inter-rater agreement of parents and teachers on behavioral problems of 58 youth with ASD and 42 youth without an ASD diagnosis. Parents and teachers of 26 youth with ASD (M?=?4.08, SD?=?1.02) and 21 youth with non-ASD diagnoses (M?=?4.38, SD?=?0.80), ages 2–5 years, and 32 youth with ASD (M?=?7.47, SD?=?1.44), and 21 youth with non-ASD diagnoses (M?=?7.71, SD?=?1.23), ages 6–10, completed the Child Behavior Checklist and Teacher Report Form. Compared to youth with a non-ASD diagnosis (ages 2–5 years), youth with ASD also had poor to moderate agreement across subscales with the exception of comparable substantial agreement on Externalizing Behavior (ICC?=?0.73 and ICC?=?0.63, respectively) and Aggressive Behavior subscales (ICC?=?0.72 and ICC?=?0.69, respectively). Compared to youth with a non-ASD diagnosis (ages 6–10 years), youth with ASD similarly had poor agreement across subscales with the exception of moderate agreement on Anxious/Depressed subscale (ICC?=?0.41 and ICC?=?0.06, respectively). These results suggest that the severity and prevalence of behavior problems in youth may depend on the context and reporter of the symptoms.     

Mentoring Youth with Psychiatric Disorders: The Impact on Child and Parent Functioning

ABSTRACT

This study examined the effectiveness of a behavioral mentoring program aimed at serving youth with psychiatric disorders. Participants included 30 youth (8–12 years old) receiving services in a mentoring program for a mental health population and 30 wait-listed youth and their maternal caregivers. Participating in mentoring services was related to higher family functioning across a number of domains including child behavior, parenting stress, perceived parent social support, and perceived parent-child relationship quality. As predicted, parenting stress mediated the relationship between mentoring and children's externalizing behavior problems. Results suggest that mentoring services may be a useful adjunct service for highly stressed families with children with emotional and behavioral disorders.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.     

Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach

Given the relationship between internalizing disorders and deficits in emotion regulation in youth, the emotion science literature has suggested several avenues for increasing the efficacy of interventions for youth presenting with anxiety and depression. These possibilities include the identification and addition of emotion-regulation skills to existing treatment packages and broadening the scope of those emotions addressed in cognitive-behavioral treatments. Current emotion-focused interventions designed to meet one or both of these goals are discussed, and the developmental influences relevant to the selection of emotion-focused treatment goals are explored using the framework of a modal model of emotion regulation. These various lines of evidence are woven together to support the utility of a novel emotion-focused, cognitive-behavioral intervention, the Unified Protocol for the Treatment of Emotional Disorders in Youth, a transdiagnostic treatment protocol that aims to treat the range of emotional disorders (i.e., anxiety and depression) simultaneously. Avenues for future directions in treatment outcome and assessment of emotion regulation are also discussed.     

Repetitive Behavior in Neurodevelopmental Disorders: Clinical and Translational Findings

Repetitive behavior refers to a highly heterogeneous set of responses associated with a wide range of conditions, including normative development. Treatment studies for aberrant repetitive behavior are limited although one promising approach involves conceptualizing such behavior as a generalized inflexibility or lack of variability in responding. Relatively little is known about the neurobiological mechanisms that mediate the development and expression of repetitive behavior, information critical to the design of effective pharmacotherapies, early interventions, and prevention strategies. We will review clinical findings in repetitive behavior as well as findings from animal models highlighting environmental factors and the role of cortical-basal ganglia circuitry in mediating the development and expression of these behaviors. Findings from animal models have included identification of a specific neural pathway important in mediating repetitive behavior. Moreover, pharmacological studies that support the importance of this pathway have led to the identification of novel potential therapeutic targets. Expanding the evidence base for environmental enrichment-derived interventions and focusing on generalized variability in responding will aid in addressing the broader problem of rigidity or inflexibility.     

Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8–12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child’s age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children’s mental health may improve service utilization patterns in this population.     

Transdiagnostic Theory and Application of Family-Based Treatment for Youth with Eating Disorders

This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.     

微生物与行为和精神疾病

病原微生物能够影响宿主的大脑和行为, 甚至诱发精神疾患。肠道细菌可影响小鼠的神经系统发育和行为模式的发展。慢性胃肠病、慢性疲劳综合征等生理疾病中的行为改变与微生物有关; 肝性脑病、多发性硬化等中枢神经系统生理疾病也可能由微生态改变引起; 抑郁症、孤独症等精神疾病与肠道细菌状态和比例有关; 卫生假说支持上述观点。建立良好的共生微生物平衡有利于人类身心健康。可以预期, 共生微生物与身心健康的关系将是今后心理学研究的关注热点。     

Adaptive memory: Animacy effects persist in paired-associate learning

Recent evidence suggests that animate stimuli are remembered better than matched inanimate stimuli. Two experiments tested whether this animacy effect persists in paired-associate learning of foreign words. Experiment 1 randomly paired Swahili words with matched animate and inanimate English words. Participants were told simply to learn the English “translations” for a later test. Replicating earlier findings using free recall, a strong animacy advantage was found in this cued-recall task. Concerned that the effect might be due to enhanced accessibility of the individual responses (e.g., animates represent a more accessible category), Experiment 2 selected animate and inanimate English words from two more constrained categories (four-legged animals and furniture). Once again, an advantage was found for pairs using animate targets. These results argue against organisational accounts of the animacy effect and potentially have implications for foreign language vocabulary learning.     

Animacy and competition in relative clause production: a cross-linguistic investigation

This work investigates production preferences in different languages. Specifically, it examines how animacy, competition processes, and language-specific constraints shape speakers' choices of structure. English, Spanish and Serbian speakers were presented with depicted events in which either an animate or inanimate entity was acted upon by an agent. Questions about the affected participant in these events prompted the production of relative clauses identifying these entities (e.g., the bag the woman is punching). Results indicated that in English, animacy plays a strong role in determining the choice of passive structures. In contrast, it plays a less prominent role in Spanish and Serbian structure choices, where more active structures were produced to varying degrees. Critically, the semantic similarity between the agent and the patient of the event correlated with the omission of the agent in all languages, indicating that competition resulted in the agent's inhibition. Similarity also correlated with different functional choices in Spanish. The results suggest that similarity-based competition may influence various stages of production planning but its manifestations are constrained by language-specific grammatical options. Implications for models of sentence production and the relationship between production and comprehension are discussed.     

Methodological Issues in Treatment Research for Anxiety Disorders in Youth

This article identifies and addresses three methodological domains relevant to the treatment of anxiety disorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status. Multiple-method measurement issues include child and parent reports, observations, and structured interviewing. Our examination of change issues considers comorbidity, analyzing the intent-to-treat sample, treatment spillover, and clinical as well as statistical significance. Problems are identified and potential ameliorative strategies are offered.     

Nonsuicidal Self-Injury in Adolescents Placed in Youth Welfare and Juvenile Justice Group Homes: Associations with Mental Disorders and Suicidality

Nonsuicidal self-injury (NSSI) is a frequent phenomenon in adolescents, however there is a lack of studies on the prevalence of NSSI in adolescents placed in youth welfare and juvenile justice group homes. The goal of the present study is to investigate the prevalence rates of NSSI and mental disorders in adolescents living in the youth welfare system, as well as how occasional and repetitive NSSI differ with respect to mental disorders, suicidality, and gender. The sample consisted of 397 adolescents aged 12 to19 years (mean age = 15.98, SD = 1.77, 65.7% male) placed in youth welfare and juvenile justice group homes. NSSI, suicidality, and mental disorders were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS-PL). Lifetime prevalence rates of occasional and repetitive NSSI were 21.9% and 18.4%, respectively and 85.6% of the sample endorsed a lifetime mental disorder. Occasional and repetitive NSSI were significantly associated with depressive, conduct, and substance use disorders (d = 0.50–0.67) among both genders. Prevalence rates of repetitive NSSI in youth welfare and juvenile justice institutions are higher than in the general population and males who engage in NSSI are at particularly high risk of suicidality. Due to the high prevalence of NSSI and its related problems, NSSI should be routinely assessed in this vulnerable population and staff should be trained in recognizing and handling NSSI as well as supporting adolescents in improving their emotion regulation skills.     

The Internal Structure of the Aberrant Behavior Checklist Irritability Subscale: Implications for Studies of Irritability in Treatment-Seeking Youth With Autism Spectrum Disorders

Given the prominence of the Aberrant Behavior Checklist (ABC), Irritability Subscale (ABC-I), in treatment outcome studies, we conducted a critical examination of its internal consistency and relationship to other measures of irritability in 758 psychiatrically hospitalized youth with autism spectrum disorder. In exploratory and confirmation samples, we conducted factor and bifactor analyses to describe the internal structure of the ABC-I. Our results suggest that the ABC-I roughly represents a unidimensional construct of irritability, as indicated by a general factor in bifactor analysis. In addition to irritability, subordinate factors are presented that represent tantrums, verbal outbursts, self-harm, and negative affect. Notably, self-harm items explain a large proportion of variance independent of irritability. Therefore, their contribution in analyses of treatment effects should be considered. Further study or revision of the ABC-I may improve convergent validity with transdiagnostic formulations of irritability as well as prevent confound from self-harm in treatment studies for irritability in ASD