Adherence-health status relationships in childhood diabetes

Used 24-hr recall interviews to assess adherence in a sample of seventy-eight 6- to 19-year-olds with insulin-dependent diabetes mellitus over a 3-month period. Thirteen adherence measures were quantified and grouped into six adherence factors (Injection, Exercise, Diet Type, Testing/Eating Frequency, Calories Consumed, and Concentrated Sweets). Prevailing glucose levels over a 2- to 3-month interval were indexed by glycosylated hemoglobin A1c (HA1c) and glycosylated serum protein (GSP) assays. Fasting triglycerides (TRIG) and total cholesterol (CHOL) assays were used to estimate lipid metabolism. Adolescents were generally less adherent than their young counterparts. Using hierarchical multiple-regression techniques, HA1c and GSP were not reliably predicted by most of the adherence factors; only Calories Consumed showed any predictive power. No significant regression equations emerged for CHOL. In contrast, TRIG was significantly associated with five of the six adherence factors; in all cases, adherence interacted with the patients' metabolic status (as defined by HA1c) at study entry, suggesting that adherence had different effects for youngsters in good versus poor diabetes control.     

Father-absent adolescents with insulin-dependent diabetes mellitus: A population at risk?

This study evaluated whether family structure is associated with the psychosocial functioning and physical health of adolescents with insulin-dependent diabetes mellitus (IDDM). Subjects were 30 intact families and 30 father-absent families. Adolescents and their mothers completed several self-report and observational instruments that assessed adolescent adherence to treatment, adolescents' and mothers' perceptions of maternal support and nonsupport of treatment, mothers' parental competence, and adolescent social competence. Metabolic control was determined by averaging the adolescent's hemoglobin A1c levels during the previous year. A 2 × 2 (Family Structure × Gender) analysis of variance was conducted on each dependent measure. The results showed that father-absent adolescents had better adherence to the IDDM treatment regimen, despite the fact that adolescents from intact families reported significantly more maternal support for treatment. In addition, single mothers reported relatively high parental competence; and statistical interaction effects indicated that single mothers of girls were more involved in the daily treatment of IDDM, consisting of both positive and negative interactions, than single mothers of boys. There were no between-groups differences for adolescents' metabolic control or social competence. Together, these findings suggested that the father-absent adolescents have adjusted very well to living with one parent and a chronic illness.     

Psychological Treatment Improves Hemoglobin A1c Outcomes in Adolescents with Type 1 Diabetes Mellitus

Adolescents diagnosed with Type 1 Diabetes Mellitus often exhibit reduced adherence to their medical regimen and poor glycemic control. A retrospective study examined longitudinal hemoglobin A1c (HgbA1c) outcomes for adolescent patients referred to the psychology service embedded within an endocrinology clinic. Three patient groups were examined: (1) Treatment: 59 adolescents referred who engaged in psychotherapy; (2) No Treatment: 40 adolescents referred yet failed to initiate psychotherapy; (3) Control: 58 adolescents not referred for treatment and matched on demographics to the two treatment groups. Over 1 year, the Treatment group had a sustained decrease in HgbA1c while the No Treatment and Control groups had an overall increase in HgbA1c. At study end, the Treatment group had HgbA1c values that were not significantly different from patients who were not considered in need of psychological treatment (Control). Adolescents that utilized the pediatric psychology service saw decreased HgbA1c values over time.     

Development and Open Trial of a Depression Preventive Intervention for Adolescents With Attention-Deficit/Hyperactivity Disorder

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for experiencing unipolar depressive symptoms and disorders. The current study describes the development of a behaviorally oriented depression preventive intervention tailored for adolescents with ADHD targeting variables empirically shown to mediate ADHD and depression (i.e., reward responsivity, emotion regulation, and family support). Eight adolescents with a history of ADHD and currently elevated depressive symptoms and their parents participated in an open trial of the Behaviorally Enhancing Adolescents’ Mood (BEAM) program. Adolescents and their parents reported high satisfaction with BEAM. Staff reported BEAM was easy to implement with high adherence. Following BEAM, there were significant reductions in parent-report of adolescents’ depressive symptoms and emotion regulation at posttreatment and the 6-week follow-up and adolescent-report of reward responsivity at posttreatment. Case vignettes are also provided to illustrate implementation of the BEAM program. In spite of the small sample, lack of a control group, and some discrepancies across informants, results overall support the feasibility and acceptability of the BEAM program, and suggest it has promise in reducing depressive symptoms in adolescents with ADHD.     

Treatment adherence among Latina female adolescent suicide attempters

Clinicians must identify factors among suicide-attempting adolescents and their families that increase treatment adherence. Researchers assessed a consecutive series of 140 disenfranchised Latina adolescents (ages 12-18 years) and their mothers presenting at a large urban emergency room after a suicide attempt by the adolescent. Adherence was examined as it related to service delivery, individual background characteristics, and psychosocial factors (current symptomatology, treatment attitudes). Each factor was found to predict adolescent treatment adherence. Adolescents receiving a specialized emergency room program, those with a diagnosis of disruptive behavior disorder, and those from single-parent households attended significantly more therapy sessions compared to their suicide-attempting peers receiving standard emergency room care. Adolescents with a diagnosis of anxiety disorders and those whose mothers reported more psychopathology and perceived more cohesive family relationships tended to attend significantly fewer treatment sessions. The implications for the delivery of emergency room interventions are discussed.     

Health-Related Quality of Life and Adaptive Behaviors of Adolescents with Sickle Cell Disease: Stress Processing Moderators

The objective of this study was to examine resilience among adolescents with sickle cell disease (SCD), focusing on the interaction of health-related quality of life with stress processing to explain adaptive behavior. Forty-four adolescents with SCD completed paper-and-pencil measures of health-related quality of life, appraisals (hope), pain coping strategies (e.g. adherence), and adaptive behavior. Self-reported health-related quality of life was significantly associated with adaptive behavior, as was adherence. Findings for moderation were mixed. Pain coping strategies moderated the association of health-related quality of life with adaptive behavior such that at lower levels of Coping Strategies Questionnaire (CSQ) Adherence, better quality of life was associated with higher adaptive behavior. Similarly, at higher levels of hope, better quality of life was associated with higher adaptive behavior, and poorer quality of life was associated with lower adaptive behavior. Adolescents with SCD showed resilience, particularly in terms of personal adjustment, that may be explained by their appraisals and stress processing strategies. Interventions to support an optimistic or hopeful outlook and improve adherence to recommendations for medical management of sickle cell pain may result in improved resilience/adaptive behavior.     

The test of time: predictors and effects of duration in youth mentoring relationships

The effects and predictors of duration in youth mentor relationships were examined. The study included 1,138 young, urban adolescents (Mean age = 12.25, all of whom applied to Big Brothers Big Sisters programs. The adolescents were randomly assigned to either the treatment or control group, and administered questions at baseline and 18 months later. Adolescents in relationships that lasted a year or longer reported the largest number of improvements, with progressively fewer effects emerging among youth who were in relationships that terminated earlier. Adolescents who were in relationships that terminated within a very short period of time reported decrements in several indicators of functioning. Older adolescents, as well as those who had been referred for services or had sustained emotional, sexual or physical abuse, were most likely to be in early terminating relationships, as were married volunteers aged 26–30 and those with lower incomes. Several dyadic factors were also found to be related to earlier terminations, including race, gender, and relationship quality.     

Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) have overlapping target populations and treatment goals. In this study, these interventions were compared on their effectiveness using a quasi-experimental design. Between October, 2009 and June, 2014, outcome data were collected from 697 adolescents (mean age 15.3 (SD 1.48), 61.9% male) assigned to either MST or FFT (422 MST; 275 FFT). Data were gathered during Routine Outcome Monitoring. The primary outcome was externalizing problem behavior (Child Behavior Checklist and Youth Self Report). Secondary outcomes were the proportion of adolescents living at home, engaged in school or work, and who lacked police contact during treatment. Because of the non-random assignment, a propensity score method was used to control for observed pre-treatment differences. Because the risk-need-responsivity (RNR) model guided treatment assignment, effectiveness was also estimated in youth with and without a court order as an indicator of their risk level. Looking at the whole sample, no difference in effect was found with regard to externalizing problems. For adolescents without a court order, effects on externalizing problems were larger after MST. Because many more adolescents with a court order were assigned to MST compared to FFT, the propensity score method could not balance the treatment groups in this subsample. In conclusion, few differences between MST and FFT were found. In line with the RNR model, higher risk adolescents were assigned to the more intensive treatment, namely MST. In the group with lower risk adolescents, this more intensive treatment was more effective in reducing externalizing problems.     

Predictors of Therapist Adherence and Emotional Bond in Multisystemic Therapy: Testing Ethnicity as a Moderator

This study examined the interaction between problem severity and race\ethnicity as a predictor of therapist adherence and family-therapist emotional bond. Data for this study came from a longitudinal evaluation of Multisystemic Therapy (MST) provided by licensed MST provider organizations in community settings. Outcome variables included mid-treatment levels of caregiver report of therapist adherence, changes in caregiver report of therapist adherence over the course of treatment, and overall levels of caregiver-therapist and youth-therapist emotional bond. Hypothesized predictors included race\ethnicity and levels of poly-substance use, externalizing behavior, and youth self-report of delinquency early in treatment as well as pre-treatment number of arrests. Participants were 185 adolescents (M age = 15.35, SD = 1.29) and their caregivers. Of the participating youth, 48 % self-identified as Caucasian, 20 % as African-American, 28 % as Hispanic\Latino, and 4 % as “other.” Two-level Hierarchical Linear Modeling analyses revealed that for Caucasian youth, lower rates of self-reported delinquency were associated with greater increases in caregiver report of therapist adherence over the course of MST. For Hispanic\Latino caregivers, higher externalizing behavior and poly-substance use were associated with reports of lower therapist adherence at mid-treatment and poorer overall levels of emotional bonding with therapists. In contrast, for African-American participants, higher levels of youth externalizing behavior and poly-substance use were associated with higher overall levels of caregiver and youth report of emotional bonding with therapists, respectively. Results provide evidence that race\ethnicity interacts with problem severity in predicting therapist adherence and family-therapist emotional bond within real-world practice settings and suggest possible therapeutic process differences across race.     

Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior

Objective

The aim of the present study was to determine whether psychopathic traits act as a predictor and/or moderator of the effectiveness of Multisystemic Therapy (MST).

Method

The sample included N?=?256 adolescents (188 boys and 68 girls) referred for conduct problems, randomized to MST or Treatment As Usual (TAU). The mean age was 16 years (SD?=?1.31). Assessments were carried out before and immediately after treatment (6 months later). Three psychopathic traits (callous/unemotional traits, narcissism, and impulsiveness) were assessed with parent reports. Adolescents and parents were informants on externalizing problems.

Results

MST was more effective than TAU in decreasing externalizing problems for the “lower callous/unemotional” and “lower narcissism” group, but not for the “high callous/unemotional” and “high narcissism” group (moderators). Impulsiveness was found to predict more post-treatment externalizing problems rated by adolescents (predictor), but not more post-treatment externalizing problems rated by parents.

Conclusions

These findings point out the clinical relevance of adequately assessing psychopathic traits in adolescents referred for treatment of antisocial behaviour, and identifying those adolescents who show high levels of these traits. It is important to tailor MST specifically to meet the needs of juveniles with high levels of callous/unemotional traits and high levels of narcissism to obtain the same level of effectiveness as with juveniles scoring lower on these traits.     

The relationship between religion and the on-road behaviour of adolescents in Iran

Iran has a high traffic fatality rate and a substantial proportion of those killed on the road are adolescents. The aim of the present study was to examine the relationship between dimensions of religiosity and the on-road behaviour of adolescents as pedestrians, cyclists and other non-driving activities. A total of 1111 students attending secondary schools in Tehran (Iran) completed the Adolescent Road User Behaviour Questionnaire (ARBQ) and the Duke University Religion Index (DUREL). This study found that adolescents who participated less often in private religious activities were more likely to be: male, have relatives or friends who had been killed in a road collision, previously involved in a road crash themselves and engaged more often in dangerous playing on the road. Adolescents reporting higher levels of religious attendance and intrinsic religiosity were more likely to be: male, without a traffic accident history, younger, from public schools, studying at schools in large urban areas and more frequently engaged in planned protective behaviours. Adolescents with higher involvement in intrinsic religiosity tended to be those: without an accident history, who did not have relatives or friends that had been killed in a crash and who engaged less frequently in unsafe road crossing behaviour. The findings of this study indicate that the different dimensions of religiousness are related to adolescents’ behaviour on the road. Thus, it appears that religion may have a role to play in improving the road safety of adolescents in Iran.     

Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation of Multisystemic Therapy (MST), an intensive, home and community-based treatment originally used with antisocial youth, for improving asthma management. We present a case study to illustrate the treatment model. Feasibility was demonstrated with eight African American adolescents with chronic, persistent asthma, suggesting that further evaluation of MST for youth with asthma and poor illness management is warranted.     

The efficacy of a universal school-based program to prevent adolescent depression

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program-Adolescents (RAP-A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP-A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.     

The Effect of General Creative Personality and Freedom of Task Choice on Adolescents' Social Creativity

This study investigated the effect of general creative personality and freedom of task choice on the social creativity of adolescents. The results indicated, first, that senior high school students scored higher than junior high school students. Second, girls scored higher than boys on originality, fluency, flexibility, appropriateness, and utility with regard to creative social problem‐solving. Third, freedom of task choice and its interaction with creative personality had significant effects on the originality, appropriateness, utility, flexibility, and fluency of social creativity. Adolescents who completed the task voluntarily scored higher on these dimensions than adolescents who completed it reluctantly and, among the voluntary adolescents, those with high and medium creative personality scored higher than those with low creative personality, whereas no such difference was found among the reluctant adolescents. Adolescents were more likely to show social creativity, and their general creative personality was more likely to be brought into effect under the freedom of task choice condition.     

Neural correlates of rumination in adolescents with remitted major depressive disorder and healthy controls

The aim of the present study was to use fMRI to examine the neural correlates of engaging in rumination among a sample of remitted depressed adolescents, a population at high risk for future depressive relapse. A rumination induction task was used to assess differences in the patterns of neural activation during rumination versus a distraction condition among 26 adolescents in remission from major depressive disorder (rMDD) and in 15 healthy control adolescents. Self-report depression and rumination, as well as clinician-rated depression, were also assessed among all participants. All of the participants recruited regions in the default mode network (DMN), including the posterior cingulate cortex, medial prefrontal cortex, inferior parietal lobe, and medial temporal gyrus, during rumination. Increased activation in these regions during rumination was correlated with increased self-report rumination and symptoms of depression across all participants. Adolescents with rMDD also exhibited greater activation in regions involved in visual, somatosensory, and emotion processing than did healthy peers. The present findings suggest that during ruminative thought, adolescents with rMDD are characterized by increased recruitment of regions within the DMN and in areas involved in visual, somatosensory, and emotion processing.     

Multisystemic therapy: monitoring treatment fidelity

The challenges of specifying a complex and individualized treatment model and measuring fidelity thereto are described, using multisystemic therapy (MST) as an example. Relations between therapist adherence to MST principles and instrumental and ultimate outcome variables are examined, as are relations between clinical supervision and therapist adherence. The findings provide modest support for the associations between MST adherence measures and instrumental and ultimate outcomes. Results also show that adherence can be altered when clinical supervision and adherence monitoring procedures are fortified. The modest associations between adherence measures and youth outcomes argue for further refinement and validation of the MST adherence measure, especially in light of the well-established effectiveness of MST with challenging clinical populations and the increasing dissemination of MST programs.     

Re‐Acculturation and Adaptation Among Adolescents From Returned Portuguese Immigrant Families1

The aims of this study were to investigate the degree of psychological and sociocultural adaptation among adolescents from returned Portuguese immigrant families and the factors that may predict adaptation. The study sample consisted of 360 adolescents from returned Portuguese immigrant families who answered a self‐report questionnaire. A control group involving 217 Portuguese youths was also included in the study. Adolescents from returned immigrant families revealed similar levels of psychological adaptation and better sociocultural adaptation in comparison with peers who have never migrated. Predictive factors—sociodemographic and intercultural contact variables—were significantly linked to youths' adaptation. It is concluded that perceived discrimination plays an essential role in re‐acculturation outcomes.     

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.     

Depleted parental psychological resources as mediators of the association of income with adherence and metabolic control

For adolescents with Type 1 diabetes, lower family income may be associated with poorer diabetes management through depleted parental psychological resources (i.e., higher parental depressive symptoms, lower parental acceptance). Adolescents (N = 252; 46% male) aged 10-14 years with Type 1 diabetes assessed the acceptance of their mother and father (e.g., "gives me the feeling that she likes me as I am"; "she doesn't feel she has to make me over into someone else"). Mothers provided information on family income and demographics. Both mothers and fathers reported their depressive symptoms. HbA1c scores were indexed via medical records. Lower family income was associated with higher (i.e., worse) HbA1c, more mother and father depressive symptoms, and less acceptance from both parents. Mediation analyses revealed that the relationship of lower family income with metabolic control occurred indirectly through lower maternal and paternal acceptance and lower adherence. Lower family income may impair the quality of parent--adolescent relationships that are beneficial for good diabetes management.