Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.     

An External Construct Validity Study of Rorschach Personality Variables

This study examined (a) hypothesized relationships between Rorschach variables and self-report test measures relating to nominally similar aspects of personality functioning and (b) interrelationships among Rorschach variables. Sixty-two undergraduates were administered the Rorschach, Barron Ego Strength Scale, Kaplan Self-Derogation Scale, Eagly Self-Esteem Scale, Multiple Affective Adjective Checklist (MAACL), Marlowe-Crowne Social Desirability Scale, and the Rotter Locus of Control Scale. Only a few of the predictions received confirmation: inanimate movement (m) correlated, as expected, with MAACL anxiety and hostility, the egocentricity index (3r + 2)/R (R = total responses) correlated significantly with self-esteem, and human movement with minus form level (M -) correlated (inversely) with ego strength. Among the unpredicted findings were some that appear inconsistent with standard Rorschach interpretation. Rorschach variables human movement (M), and experience actual (EA), generally interpreted as reflecting coping resources, related significantly with self-report measures of poor coping and of dysphoric affect. In general, the Rorschach appears better at identifying weaknesses in the ego rather than strengths.     

Personality Variables in Rorschach Scoring

Twenty-three clinical trainees scored a standardized list of 150 Rorschach responses and were administered the EPPS. Ten directional hypotheses were advanced which predicted certain personality attributes of those making scoring errors in various determinant categories. Results showed significant differences between high and low error groups on scores on several EPPS scales, supporting four of the ten hypotheses. Scoring errors in the color, human movement, texture, and vista determinant categories were related to scores on the Exhibition, Affiliation, Autonomy, and Abasement scales, respectively. Implications of these results are discussed regarding the reliability of Rorschach interpretations.     

Changes in Rorschach Teaching

To investigate recent changes in Rorschach instruction, a double postcard questionnaire was distributed to all APA-approved doctoral programs in clinical psychology asking for information about the number and type of Rorschach courses. The data were compared with 1961 and 1966 surveys. A trend toward fewer Rorschach courses per university and a decrease in courses specifically on the Rorschach is evident. Changing views toward projective techniques may be a contributing factor, but the addition of areas such as behavior modification and community psychology into the training programs is also compressing the more traditional courses.     

The Effects of a Multiple Family Therapy on Adolescents with Eating Disorders: An Outcome Study

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty‐two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI‐2), the Outcome Questionnaire 45 (OQ‐45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ‐45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions.     

Adolescents in Residential Treatment: Caregiver and Peer Predictors of Risk Behavior and Academic Performance

The purpose of this research was to better understand the substance use and sexual risk taking behavior among high-risk adolescent populations placed in residential treatment facilities, including those in the foster care and juvenile justice systems. The primary predictors considered in this study included caregiver support, caregiver closeness, other adult support, adolescent self-disclosure/communication with caregiver, caregiver expectations about sexual behavior, and peer influence regards to drugs/alcohol and sexual behavior. Participants included 120 adolescent females in grades 7 to 12 (median grade?=?10; mean age 15.7 years), primarily African American (57.2 %) and White (29 %), in a residential treatment setting in a large urban area in the Midwest. Caregiver support and self-disclosure/communication with caregivers predicted condom use at most recent intercourse, but variables related to substance use were most consistently predictive of sexuality variables including onset and frequency of behavior. None of these support variables significantly predicted onset and frequency of substance use. Caregiver support was the contributing variable in predicting academic achievement.     

Characteristics of Children and Adolescents Admitted to a Residential Treatment Center

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.     

青少年结果预期与评价的ERP研究

大脑不断地对环境事件产生预期并将这些预期与实际结果进行比较, 通过对反馈刺激的结果评价以优化后续行为。采用抽奖式赌博任务范式, 操纵得奖的确定性程度, 利用事件相关电位技术(ERP), 研究青少年结果预期与评价的认知和神经电生理过程, 以成人作为对照组进行比较分析。研究结果表明：(1)在反映自动、快速结果评价的FRN上, 无论在高确定性还是在低确定性条件下, 青少年与成人均未表现出显著性差异; (2)组别与确定性程度在P300波幅上表现交互作用显著, 简单效应分析表明, 在高确定性条件下, 青少年组输、赢的P300波幅表现出差异; 而成人组输、赢的P300波幅无显著性差异。青少年对反馈刺激自动的快速结果评价能力已接近成人水平, 而对反馈刺激功能意义评价的控制加工能力还未发展成熟。     

Rorschach Object Relations of Adolescents Who Committed Homicide

We investigated the object relations of adolescents who committed homicide. A clinical sample of 55 adolescents who committed homicide did not differ from a comparison group of nonviolent delinquents on Rorschach measures of object differentiation, mutuality of autonomy, and aggressive content. However, the subgroup of adolescents who committed homicides in the context of another crime (e.g., robbery or burglary) did manifest significantly lower object relations (poorer object differentiation and more victim responses) than the subgroup of adolescents whose homicides were committed in the context of an interpersonal conflict or dispute with the victim. These findings support the need for differentiated classification of violent individuals as urged by Megargee (1970) over 20 years ago.     

Therapeutic Practices and Ethical Beliefs of Professionals Working With Adolescents in Residential Treatment

The authors investigated dual relationships between 2 groups of staff (direct care and professional) and adolescent clients in 2 residential treatment programs. Staff were surveyed on their behavior and corresponding ethical beliefs regarding interactions they believed to be acceptable with minor clients specifically at termination of the treatment program. Direct care staff were more likely than were professional staff to have inconsistencies in behaviors and ethical beliefs. The American Counseling Association's (1995) Code of Ethics would prohibit some of the staff beliefs regarding acceptable behavior. Both groups were uncertain about the ethical appropriateness of certain interactions with adolescent clients. Implications are discussed.     

Rorschach Egocentricity Index and Self-Concept in Children and Adolescents

In a sample of 65 child and adolescent psychiatric inpatients, the hypothesized relation between the Egocentricity Index from the Rorschach and standard self-report measures of self-concept was not supported. Although the sample as a group had a markedly tow mean Egocentricity Index, self-reported self-concept was at a normative level. The validity of the Egocentricity Index and self-report measures of self-concept is discussed, and guidelines for their interpretation are presented.     

Rorschach Changes in Long-Term Short-Term Psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 21/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

The Latent Structure of Substance Use Among American Indian Adolescents: An Example Using Categorical Variables

Researchers frequently have only categorical data to analyze and cannot, for theoretical or methodological reasons, assume that the observed variables are discrete representations of an underlying continuous variable. We present latent class analysis as an alternative method of measuring latent variables in these circumstances. Latent class analysis does not require the assumptions of factor analyses about the nature of manifest and latent variables, but does allow the use of more precise model selection than techniques such as cluster analysis. We modeled the lifetime substance use of American Indian youth. The latent class model of American Indian teenagers' substance use had four classes: Abstaining, Predominantly Alcohol, Predominantly Alcohol and Marijuana, and Plural Substance. We then demonstrated the usefulness of this latent variable by using it to differentiate levels of several variables in a manner consistent with Social Cognitive Theory.     

近十年国外罗夏测验攻击变量研究综述

用罗夏测验测量攻击有助于了解个体的攻击性冲动 ,也有助于外显攻击行为的预测和控制。近十年国外文献中有关研究者主要有Holt、Exner、Gacono和Meloy。综述结果表明 ,他们提出的大多数攻击变量都有明确的定义 ,其实证研究也获得了一些支持。但也可以看到 ,目前的研究依然存在不少问题 :(1 )变量的定义有重复、内容有交叉 ;(2 )变量的分类标准不唯一 ;(3 )某些变量的使用和操作欠方便。因而 ,这些变量的定义、分类和使用都还有待于进一步研究支持。     

Psychopathic Traits of Dutch Adolescents in Residential Care: Identifying Subgroups

The present study examined whether a sample of 214 (52.8% male, M age = 15.76, SD = 1.29) institutionalized adolescents could be classified into subgroups based on psychopathic traits. Confirmatory Factor Analyses revealed a relationship between the subscales of the Youth Psychopathic traits Inventory (YPI) and the three latent constructs of the original model on which it is based. Latent Class Analyses showed that adolescents showing psychopathic traits could be classified into three subgroups. The first group showed low scores on the grandiose/manipulative dimension, the callous/unemotional dimension, and the impulsive/irresponsible dimension (normal group). The second group scored moderate on the grandiose/manipulative dimension and the callous/unemotional dimension and high on the impulsive/irresponsible dimension (impulsive, non-psychopathic-like group). The third group scored high on all three dimensions (psychopathy-like group). The findings revealed that the impulsive, non-psychopathic like group scored significantly higher on internalizing problem behavior compared to the normal group, while the psychopathy-like and the impulsive, non-psychopathic-like group both scored higher on externalizing problem behavior compared to the normal group. Based on a self-report delinquency measure, it appeared that the psychopathy-like group had the highest delinquency rates, except for vandalism. Both the impulsive and psychopathy-like group had the highest scores on the use of soft drugs.