Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

The current study examined fear of hypoglycemia in 81 mothers and 64 fathers of young children with type 1 diabetes (T1DM) using the Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC possible range = 26–130). Mothers and fathers completed the HFS-P-YC at enrollment and mothers completed it 2 weeks later. Families recorded daily blood glucose on a standardized meter for 2 weeks. Mothers’ mean total HFS-P-YC score was 75.0 (SD = 17.2) and fathers’ mean score was 66.5 (SD = 18.0). Mothers reported greater HFS-P-YC total and behavior subscale scores than fathers. Mothers’ HFS-P-YC scores were comparable to published HFS scores for mothers of preadolescents with T1DM and higher than adult patients with T1DM. The HFS-P-YC had good internal consistency and test–retest reliability in this sample. These findings suggest parents of young children with T1DM report a high level of fear of hypoglycemia. Additionally, the HFS-P-YC appears to be a reliable measure in this population.     

A Family Systems Approach to Behavioral Training with Parents of Autistic Children

This paper reviews briefly the use of behavioral procedures and parent training techniques with parents of autistic children. Potential hazards that may arise when the clinician fails to be sensitive to the family context are examined. Behavioral clinicians are urged to undertake behavioral parent training from a family systems context and thereby enhance the likelihood of more enduring changes for the autistic child and the family as a whole. Case illustrations are provided.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

Pediatric Parenting Stress and Its Relation to Depressive Symptoms and Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

Parents of young children with type 1 diabetes (T1DM) maintain full responsibility for their child’s daily diabetes self-care and thus may be vulnerable to experiencing parenting stress. This study examined several psychological correlates of pediatric parenting stress in parents of young children with T1DM. Parents of 39 young children with T1DM (ages 2–7 years) completed measures of pediatric parenting stress, mealtime behavior problems, depressive symptoms, and fear of hypoglycemia. For parents of young children, higher stress frequency and difficulty were associated with higher parental depressive symptoms and fear. Regression analyses identified that 58% of the variance in stress frequency was associated with parental depressive symptoms. For stress difficulty, 68% of the variance was associated with parental depressive symptoms and fear. Pediatric parenting stress is common in parents of young children with T1DM. Stress and the psychological correlates measured in this study are amenable to intervention and should be regularly assessed in parents of young children with T1DM.     

利拉鲁肽与甘精胰岛素治疗初诊2型糖尿病的疗效及安全性比较

试验以对比利拉鲁肽与甘精胰岛素分别联合二甲双胍对初诊为2型糖尿病患者血糖控制效果及其安全性为目的.将60例初诊为2型糖尿病患者随机分为两组,予以利拉鲁肽(1.2u/d)及甘精胰岛素(0.3u/kg·d)分别联合二甲双胍(1g,Bid)治疗8周,比较治疗前后的血糖、糖化血红蛋白等指标.结果显示两组治疗后血糖、糖化血红蛋白均明显减低(P＜0.05);利拉鲁肽组低血糖发生率明显低于甘精胰岛素组(P＜0.05);而该组治疗后体重及收缩压下降,与胰岛素组有明显差异(P＜0.05).故对糖尿病患者,利拉鲁肽与甘精胰岛素同样有效控制血糖,而利拉鲁肽能够明显降低体重及收缩压,并且低血糖发生率更低.     

Promoting Attachment and Mentalization for Parents and Young Children in the Foster Care System: Implementing a New Training and Treatment Approach in an Agency

The Building Blocks Program is an innovative psychodynamic treatment approach that was designed to fit within a social service agency structure. It is based on concepts of attachment, attunement, and mentalization and builds on the research of Beatrice Beebe (2003), Peter Fonagy and colleagues (2002), Arietta Slade (2005), Howard and Miriam Steele (2008), and Dan Stern (1985). The Building Blocks Program targets birth mothers and their young children under age 5 who have been or are in danger of being removed from their families. In the beginning of the program, the Building Blocks therapists faced many challenges. As noted (Remez, this issue), many of the therapists were unfamiliar with a Reflective Supervision model of learning. They were accustomed to a more traditional pedagogical approach that emphasized critiquing their work, with a focus on their clients’ pathology. The Building Blocks model focuses on therapist and client safety and support, prompting a paradigm shift in the therapists’ thinking about supervision and how to conduct therapy.     

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.     

Feasibility and Preliminary Efficacy of an Internet Support Group for Parents of a Child with Neurofibromatosis Type 1: a Pilot Study

This pilot study investigated the feasibility and preliminary efficacy of an Internet Support Group (ISG) for parents of children with NF1. Eligible parents were recruited by email and completed baseline questionnaires assessing social support, self-efficacy, depression, and anxiety. The ISG involved eight weekly 90-min chat sessions and a discussion forum open 24 h/day for 8 weeks. Follow-up measures were completed immediately post-intervention and 3 months later. Parents from 33 families (29 mothers, 4 fathers) completed baseline measures. Over half of parents (52 %) rated their child’s disease severity as mild, 33 % moderate, and 15 % severe. Among 21 parents who completed post-intervention measures, ratings of perceived emotional (p = .0008) and informational (p = .0003) support increased. There were no significant changes in self-efficacy, depression, or anxiety (ps > .05). The mean satisfaction rating was moderately high (7.6/10; range 4–10). Some parents commented that the chat sessions were at inconvenient times, which may have limited participation. Preliminary evidence in this small sample of parents suggests that ISGs may be a feasible and potentially efficacious method of providing support to parents of children with NF1. Having multiple weekly chat sessions held at various days and times may improve accessibility and participation. Clinicians are encouraged to help parents access online support resources.     

Feasibility of Pairing Behavioral Activation With Exercise for Women With Type 2 Diabetes and Depression: The Get It Study Pilot Randomized Controlled Trial

Major depressive disorder is often comorbid with diabetes and associated with worse glycemic control. Exercise improves glycemic control and depression, and thus could be a parsimonious intervention for patients with comorbid diabetes and major depression. Because patients with diabetes and comorbid depression are often sedentary and lack motivation to exercise, we developed a group exercise intervention that integrates strategies from behavioral activation therapy for depression to increase motivation for and enjoyment of exercise. We conducted a 6-month pilot randomized controlled trial to test the feasibility of the behavioral activation exercise intervention (EX) for women with diabetes and depression. Of the 715 individuals who contacted us about the study, 29 participants were randomized to the EX condition or an enhanced usual care condition (EUC), which represents 4.1% of participants who initially contacted us. Inclusion criteria made recruitment challenging and limits the feasibility of recruiting women with diabetes and depression for a larger trial of the intervention. Retention was 96.5% and 86.2% at 3 and 6 months. Participants reported high treatment acceptability; use of behavioral activation strategies and exercise class attendance was acceptable. No condition differences were observed for glycemic control, depressive symptoms, and physical activity, though depressive symptoms and self-reported physical activity improved over time. Compared to participants in the EUC condition, participants in the EX condition reported greater exercise enjoyment and no increase in avoidance behavior over time. Using behavioral activation strategies to increase exercise is feasible in a group exercise setting. However, whether these strategies can be delivered in a less intensive manner to a broader population of sedentary adults, for greater initiation and maintenance of physical activity, deserves further study.     

Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children With Externalizing Disorders in a Randomized Controlled Trial

Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4–11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.     

A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children

Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias.Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks.Participants (N = 14) (M_age = 44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the “mild” severity range to the “none to minimal” range.In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.     

Development and Preliminary Feasibility Study of a Brief Behavioral Activation Mobile Application (Behavioral Apptivation) to Be Used in Conjunction With Ongoing Therapy

Depressive symptoms are the most frequently treated psychiatric condition in the United States. Brief behavioral activation treatment for depression (BATD) is a popular, evidence-based psychotherapy with strong research support for the treatment of depression. In this paper, we describe the development and initial pilot feasibility testing of a BATD mobile application (Behavioral Apptivation) to be used by patients and therapists in conjunction with BATD therapy. We present information regarding the app development process as well as results from a small open-label feasibility trial of the app utilized in conjunction with individual BATD. We include a case series from the open-label trial highlighting how Behavioral Apptivation can be utilized in clinical practice.     

Yoga in an Urban School for Children with Emotional and Behavioral Disorders: A Feasibility Study

Increasingly, school-aged children present with challenging emotional and behavioral problems and may be resistant to traditional special education approaches (Smith et al., Behav Disorders 36(3):185–194, 2011). These programs do not take into consideration the specific needs of students with emotional and behavioral disorder (EBD). We examined the feasibility and potential for positive effects of yoga sessions within a school setting for children with EBD at an urban elementary school. Thirty-seven children with EBD in an urban school completed a yoga intervention in small groups (7–10 students) twice per week for 3 ½ months. Teachers, parents, and students completed a systematic pre- and post-intervention assessment, and yoga instructors completed attendance and behavior checklists. Average attendance for the yoga sessions was 90 %. Eighty percent of responders described being very satisfied with the intervention. Teachers reported improved attention in class (p = 0.01) and adaptive skills (p = 0.03) and reduced depressive symptoms (p = 0.03), behavioral symptoms (p = 0.01), and internalizing symptoms (p = 0.04). No significant changes were found in the parent data and no discernable trend was found in student reports. These data suggest that yoga administered in small groups in an urban school setting is a feasible school intervention for children with emotional and behavioral disorders and may be effective in reducing symptoms.     

Cognitive Behavioral Therapy for Bariatric Surgery Patients: Preliminary Evidence for Feasibility,Acceptability, and Effectiveness

Bariatric surgery is the most effective treatment for extreme obesity; however, 20% to 50% of patients begin to regain their weight within the first 1.5 to 2 years following surgery. Despite some psychosocial factors predicting postoperative weight loss and weight regain, psychosocial interventions are not routinely offered in bariatric surgery programs. In this paper, we describe a 6-session cognitive behavioral therapy (CBT) intervention for preoperative and postoperative bariatric surgery patients with maladaptive eating behaviors or thought patterns, which can be delivered either in person or by telephone. In addition, we describe a small pilot study (n = 8) designed to examine the feasibility and acceptability of the CBT intervention, as well as its effectiveness in improving eating pathology and psychosocial functioning. Most pilot study participants reported improvements in binge eating severity, emotional eating, and depression from pre- to posttreatment, and all participants provided positive qualitative feedback regarding the intervention.     

Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

Implications of Psychosocial Factors for Diabetes Outcomes among Children with Type 1 Diabetes: A Review

We adopt a risk and resistance framework to review the literature on the psychosocial factors that influence diabetes outcomes—specifically self‐care behavior (blood glucose monitoring, diet, exercise, insulin administration) and glycemic control. We examine both personal and social/environmental risk and resistance factors. We conclude by suggesting conceptual and methodological directions for future research. Conceptually, we suggest that researchers examine the synergy among variables that cut across domains, mechanisms linking psychosocial factors to diabetes outcomes, and the impact of goals on health. Methodologically, we suggest that researchers examine age, gender, and race as moderator variables; utilize momentary data collection technology; and employ more sophisticated longitudinal analyses.     

Social Validity of a Training and Coaching Program for Parents of Children With Autism Spectrum Disorder on a Waiting List for Early Behavioral Intervention

Due to limited public resources, many children with autism spectrum disorder and their families must wait several months, if not years, to access early behavioral intervention (EBI) services. Service providers must thus develop alternative support models to assist families placed on waiting lists. The present study assessed the social validity of one such initiative, a training and coaching program for parents whose children had been put on a waiting list for EBI services. This program consisted of group training sessions on strategies to cope with their child’s disorder based on applied behavioral analysis and on one-hour, weekly follow-up meetings to support parents’ interventions with their child over the course of 12 months. Social validity was assessed through parental satisfaction with this program and their perception of its effects on themselves, the family, the child, and parental stress. The 94 participants were generally satisfied with the program overall, although they wished for more frequent and intensive interventions. They reported that the program had positive effects on their psychological well-being, their family’s quality of life, and their child’s behavior. However, parenting stress levels were found to have increased over the 12-month period. These results demonstrate that training and individually supporting parents can be beneficial for families of children with ASD who cannot have access to early behavioral intervention immediately upon receiving a diagnosis. Importantly, however, these lower-cost, parent-focused programs cannot be considered a substitute for more intensive and children-driven services.     

Development of an Intervention for Foster Parents of Young Foster Children with Externalizing Behavior: Theoretical Basis and Program Description

Foster parents are often faced with serious externalizing behaviors of their foster child. These behavioral problems may induce family stress and are related to less effective parenting and often increase. Foster children with behavioral problems are also more at risk of placement breakdown. An intervention to support foster parents of young foster children with externalizing behaviors is necessary to improve the effectiveness of foster placements. Based on research on effective parenting interventions and special needs of foster children, a treatment protocol was developed. This paper describes theoretical foundations for the content and form of the intervention and gives an overview of the modular treatment protocol. Preliminary outcomes of this intervention as well as challenges and future developments and research activities are discussed.     

Sensory Processing Difficulties, Behavioral Problems, and Parental Stress in a Clinical Population of Young Children

This study examined the relationship between sensory processing difficulties, parental stress, and behavioral problems in a clinical sample of young children with developmental and behavioral difficulties. We hypothesized that a high rate of sensory processing difficulties would be found, that there would be a high rate of comorbidity between sensory processing difficulties and behavioral problems, and that children’s sensory processing difficulties and parental stress would be highly correlated. Parents of 59 children ages two to five who attended an out-patient clinic in a low income, urban community completed the Child Behavior Checklist, Parental Stress Inventory-Short Form and the Short Sensory Profile. Children in this clinical population showed a high prevalence (55.9 %) of sensory processing difficulties, a significantly higher rate than previously reported. Sensory processing deficits were correlated with behavioral difficulties and parental stress levels-suggesting that as sensory processing difficulties increase, so do behavioral difficulties and parental stress. Parents of children with sensory processing deficits had significantly higher levels of parental stress than parents of children without sensory deficits. Parenting stress levels were also clinically elevated for the cohort of children in which sensory processing difficulties and behavioral concerns co-existed. These findings suggest that treatment outcomes might improve and parental stress could be reduced if mental health clinicians were trained to identify and address sensory problems. This could result in more children being screened and treated for sensory processing difficulties and an eventual reduction in the rates of parental stress.