Family-based Psychoeducation for Children and Adolescents with Mood Disorders

Psychoeducation is often used for family members of adult patients with mood disorders. An increase in family’s knowledge of the patient’s illness course and outcome is thought to improve treatment compliance and may reduce relapse rates through identification of early symptoms and risks. While studies on family-based psychoeducation of adult patients with mood disorders have been reviewed, a similar review has not been conducted in patients who are children and adolescents. We conducted a systematic review of studies published between 1980 and 2006 on independently standing psychoeducation programs for families with children suffering from mood disorders. Results revealed eight treatment and preventive psychoeducation studies for families of affectively ill children or children at risk for depression. Findings indicate that psychoeducation models typically adopt a workshop approach incorporating didactic teachings and interactive discussion sessions, with or without specific skills training. Given the paucity of randomized controlled trials and lack of comparability between psychoeducation models, conclusions about the true efficacy of each program as a treatment or an adjunct to the treatment of mood disorders in children and adolescents cannot be made. Further research into psychoeducation for families of children with mood disorders is warranted.     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

儿童和少年情绪障碍相关社会心理因素探讨

儿童和少年情绪障碍是一组由家庭环境因素、认知倾向和个性心理等多种社会心理因素共同作用、相互影响的疾病。家庭是一个系统,对儿童和少年的心理和行为的塑造存在影响。家庭环境和个性因素是以认知倾向为中介产生对情绪的影响,家庭环境因素又影响了认知倾向的形成和个性的发展。从以上三个方面进行探讨,旨在为儿童和少年情绪障碍者的心理干预提供科学的理论依据。     

Effectiveness of the Wraparound Process for Children with Emotional and Behavioral Disorders: A Meta-Analysis

Wraparound is a team-based service planning and coordination process intended to improve outcomes for children and youth with serious emotional and behavioral disorders and support them in their homes, schools, and communities. Given the substantial resources devoted to implementing wraparound, a meta-analysis of outcome studies was conducted to better understand current empirical support for this process. A literature search identified seven studies between 1986 and 2008 that documented the effects of youth receiving wraparound compared to control groups. Mean treatment effects across outcome domains ranged from medium for youth living situation (0.44) to small for mental health outcomes (0.31), overall youth functioning (0.25), school functioning (0.27), and juvenile justice-related outcomes (0.21). The overall mean effect size across studies was 0.33. Interpretation of results was complicated by the lack of consistent documentation of implementation fidelity across studies and conditions, variations in target population and intended outcomes, and methodological concerns. The authors conclude that, though the published wraparound research base is expanding and findings are largely positive, it continues to be in a preliminary state of development. However, there are insufficient data to support calls for wraparound’s acceptance or dismissal based on the strength of existing studies.     

Educational Success in High-Risk Settings: Contributions of the Chicago Longitudinal Study

I provide an overview of the Chicago Longitudinal Study. This prospective study traces the educational and social success of a large sample of low-income children (over 90% of whom are African American) from high-poverty neighborhoods in the Chicago Public Schools. In 1985–1986, the sample participated in the Child–Parent Centers and other early childhood programs. The four studies reported in this special issue highlight the contributions of school mobility, parent involvement, educational expectations, and other family and school experiences in preventing learning problems and promoting educational success.     

Posttraumatic Stress Disorder in Children and Adolescents: A Review and Analysis

Only recently has the mental health community recognized the applicability of diagnostic criteria for posttraumatic stress disorder (PTSD) in children and adolescents, including a consideration of specific age-related features. This paper provides a current review of the literature on PTSD pertaining to children and adolescents. Following a discussion of issues on diagnostic criteria and assessment of this affective disorder in this population, there is an overview of the existing literature on prevalence, comorbidity, risk factors, parental and family factors, and issues of gender and age of onset. The remainder of the paper focuses on the range of traumatic stressors in children and adolescents that can result in PTSD, including natural or human disasters, war and violence, chronic or life-threatening medical conditions, community violence and the witnessing of traumatic events, and physical and/or sexual abuse and other forms of interpersonal violence. Throughout the paper, there is an emphasis on the importance of considering developmental factors. Finally, implications of the existing literature for future areas of research are addressed.     

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.     

Recognition of Facial Expressions of Emotion by Children with Emotional and Behavioral Disorders

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.     

Developmental and Adjustment Issues of Gay, Lesbian, and Bisexual Adolescents: A Review of the Empirical Literature

Various studies have reported adjustment problems experienced by gay, lesbian, and bisexual (GLB) adolescents. A primary purpose of this paper is to critically review this literature. Difficulties that have been studied include past suicide attempts, substance use and abuse, conduct problems, and academic concerns. For example, a considerable number of GLB youth report a history of suicide attempts, with prevalence rates ranging from 11 to 42%. However, among other methodological concerns, studies in this area have not used a comparison sample of heterosexual youths. Characteristics of development particular to GLB adolescents are described, the empirical research on adjustment issues is reviewed, and potential risk and protective factors for GLB youths are discussed.     

Skills for Social and Academic Success: A School-Based Intervention for Social Anxiety Disorder in Adolescents

This paper describes Skills for Academic and Social Success (SASS), a cognitive–behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their childs anxiety. Initial findings regarding the programs effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.     

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.     

How REBT Can Be Less Disturbing and Remarkably More Influential in Britain: A Review of Views of Practitioners and Researchers

We asked British cognitive behaviour therapists and researchers for their views on the current status of Rational Emotive Behaviour Therapy in Britain. All agreed that REBT had lost influence in comparison with Cognitive Therapy since the cognitive revolution 20 years ago. The main reasons given were that REBT, particularly in comparison with CT, was under-researched, was too rationalist in its approach and too active/directive in its style. One responder thought REBT was remarkably atheoretical. Overall there was a surprising degree of ignorance and misinformation. On the positive side, REBT was felt to be focused on the person rather than the symptom, and oriented more to the client than the professional or academic in its publication output than CT. We consider each issue and make recommendations for change.     

Using Cognitive Behavior Therapy in Clinical Work With African American Children and Adolescents: A Review of the Literature

A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. Se presenta una reseña exhaustiva de la literatura sobre trabajo clínico con jóvenes Afroamericanos usando terapia cognitiva conductual (TCC). Se perfilan los puntos fuertes y las limitaciones de la TCC en relación a esta población. A pesar de que la TCC muestra signos prometedores para servir de ayuda, no hay suficiente investigación sobre la eficacia y efectividad de la TCC en este grupo.     

Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Outcomes in a System of Care for Youths with Emotional and Behavioral Disorders: An Examination of Differential Change Across Clinical Profiles

We assessed the utility of an empirically-derived classification system for youths with emotional and behavioral disorders in a system of care with a strong representation of juvenile delinquents. Eighty-seven youths served in a system of care were categorized by variables related to past history, current behavioral functioning, and current psychological functioning into four clinical clusters. We evaluated preliminary clinical outcomes after six months of interagency involvement for youths within each cluster and across the four clusters. Results indicated that youths in different clusters improved significantly in need-specific areas. Trends in our data indicated differential change in clinical outcomes across clusters. We discuss our findings within the context of emerging outcomes of youths involved in comprehensive community-based programs and consider implications for outcome research, treatment of juvenile delinquents, and mental health policy.     

Academic Performance of Students with Emotional and Behavioral Disorders Served in a Self-Contained Setting

This study describes the academic, social, and behavioral performance of elementary and secondary students with emotional and behavioral disorders (EBD) receiving services in a self-contained school for students with serious behavior problems, with an emphasis on how school adjustment and problem behavior patterns predict academic performance. Results revealed that elementary and secondary group scores were well below the 25th percentile on reading, math, and written expression measures. Further, a seven variable model representing academic, social, and behavioral domains was able to differentiate between age groups explaining 54% of the variance and correctly classifying 78.26% (n = 18) of the elementary students and 84.21% (n = 16) of the secondary students. Findings also suggested that behavioral variables (e.g., school adjustment, externalizing, and internalizing) were predictive of broad reading and broad written expression scores, with school adjustment (a protective factor) accounting for the most variance in the three-variable model. Limitations and recommendations for future research are addressed.     

Anxiety and Depression in Children and Adolescents: A Factor-Analytic Examination of the Tripartite Model

The tripartite model of Clark and Watson (1981) suggests that the oft-observed covariation between anxiety and depression can best be understood by examining three related yet distinct constructs: negative affectivity, positive affectivity, and elevated physiological arousal. In the present study, 510 boys and girls in the 4th, 7th, and 10th grades completed the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Confirmatory factor analyses were conducted to determine the goodness of fit of single-factor (i.e., negative affectivity), two-factor (i.e., anxiety and depression), and three-factor models (i.e., negative affectivity, positive affectivity, and physiological arousal). Analyses were conducted by examining each of the models in the whole sample first and then separately for boys and girls and for fourth, seventh, and tenth grade youths. Results failed to support the tripartite theory; rather, the findings supported a two-factor model in all cases. These factors represented the general constructs of anxiety and depression, and these factors remained significantly interrelated. Consistent with previous findings, the strength of these relations was stronger for boys than girls and for children than adolescents.