Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior

The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and at school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 × 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.Completion of this investigation was facilitated by a Research Scientist Development Award (MH00353) and a grant (MH35408) from the National Institute of Mental Health. The author is grateful for the assistance of the clinical research team of the Child Psychiatric Treatment Service, especially that of Irene Heidish, M.A., who assisted with the data analyses.     

Convergence of clinically derived diagnoses and parent checklists among inpatient children

The extent to which parent rating scales differentiated children according to DSM III diagnoses was examined. A total of 113 psychiatric inpatient boys (ages 6–11) were rated by their mothers or maternal figures on the Child Behavior Checklist (CBCL) and the Behavior Problem Checklist (BPC). Children with DSM III diagnoses of conduct disorder or depression were compared to children without these diagnoses. Externalizing and internalizing scales of the parent checklists and additional measures of child aggression and depression differentiated children according to major diagnoses. The use of parent checklists to classify children indicated a high level of sensitivity for both CBCL and BPC scales for diagnosing conduct disorder and depression. However, specificity of the subscales, particularly for the CBCL, was relatively low, indicating a high rate of false positives. The need for further work that extends the range of diagnosis, that examines subtypes of disorders, and that increases the specificity of the measures for diagnostic purposes is discussed.Completion of this project was supported by a Research Scientist Development Award (MH00353) and a grant (MH35408) from the National Institute of Mental Health, and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915) from the National Institute of Mental Health. The authors are grateful to Elaine Meyer, Karen Esveldt-Dawson, Antoinette Rodgers, and the clinical research team and staff of the Child Psychiatric Treatment Service.     

Distress in spouses of chronic pain patients

This paper critiques the research on distress in spouses of chronic pain patients and includes a review of two studies of spouses conducted at the Miriam Hospital Chronic Pain Research Unit. The clinical implications of this research are discussed and case material is presented to illustrate the role of spouse distress in the treatment of patients with chronic pain. Future directions for research in this area are recommended.The research conducted at the Miriam Hospital Chronic Pain Research Unit was supported by the Alcohol, Drug and Mental Health Administration of the National Institute of Mental Health, Small Grants Program, Grant No. 1 R03 MH39257001A1.     

Center for Victims of Torture--Guinea 2004-2005 International Mental Health Team: international humanitarian award

Presents the citation for the Center for Victims of Torture--Guinea 2004-2005 International Mental Health Team, who received the International Humanitarian Award "for their outstanding commitment to the healing of torture victims and to educating the world community about torture and war trauma." A brief profile of the Center is presented, as well as the Center's award address, entitled Trauma Healing in Refugee Camps in Guinea: A Psychosocial Program for Liberian and Sierra Leonean Survivors of Torture and War. ((c) 2006 APA, all rights reserved).     

Child,mother, and father evaluations of depression in psychiatric inpatient children

The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6–13) and their mothers and fathers independently completed selfreport and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between childmother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.This investigation was supported in part by a Research Scientist Development Award (1 K02 MH00353) to the first author from the National Institute of Mental Health and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915-05) from the National Institute of Mental Health. The authors are grateful to the clinical research team of the Child Psychiatric Treatment Service.     

Gender and ethnic differences in psychosocial stress and generalized distress among Hispanics

This study examined the relationship between gender, ethnicity, psychosocial stress and generalized distress in 593 Hispanic immigrants, Mexican Americans, and Anglo Americans using the Hispanic Stress Inventory (HSI) and the Center for Epidemiologic Studies Depression Scale (CES-D). Findings revealed that immigrant females had higher scores on the Cultural/Family Conflict sub-scale of the HSI and on the CES-D than immigrant males. Also, higher levels of generalized distress and psychosocial stress associated with the immigration process were found among immigrants from Central America when compared with Mexican immigrants. Central Americans' stress appraisal ratings on specific HSI items related to pre-migration trauma were significantly higher than the ratings of Mexican immigrants. Our findings indicate that research and clinical service delivery models must be sensitive to the vast heterogeneity within the Hispanic population with respect to differences in the experiences of psychosocial stress as related to gender and ethnicity.This project was partially supported by Grant USPHS MH24854 to the third author from the National Institute of Mental Health, Division of Biometry and Applied Science, Minority Research Resources Branch.     

Effects of parental alcoholism and life stress on hispanic and non-hispanic caucasian adelescents: A prospective study

Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnerability of adolescents. It extended an initial cross-sectional study of this same sample by adding two annual assessments which allowed for additional cross-sectional analyses and longitudinal tests. Hispanic and Caucasian adolescents (N=306 at Time 1) completed measures of their own life stress, family conflict, and alcohol use. Their parents reported on adolescents' internalizing and externalizing symptoms. Cross-sectional analyses at Time 2, and prospective analyses involving Time 1 and Time 2 measures were, for the most part, consistent with the original study's results. Caucasian adolescents and children of alcoholic parents appeared to be more vulnerable to stress than Hispanic adolescents and children of nonalcoholic parents. Family conflict was a partial explanation for this increased vulnerability. This research was supported by National Institute on Drug Abuse Grant DA05227 to Laurie Chassin (pricipal investigator) and Manuel Barrera, Jr. (coprincipal investigator). Susan Li was supported by an American Psychological Association Minority Fellowship Award. Portions of this research were presented at the conference, “Resiliency in Families: Racial and Ethnic Minority Families in America” that was held at the University of Wisconsin, May 31–June 2, 1994.     

The growth and development of an infant mental health program: An integrated perspective

This article details the development of the Infant Mental Health Clinical and Training Program at the University of Colorado School of Medicine from 1976 to the present. The article discusses the clinical sites where the program takes place, which include the Neonatal Intensive Care Unit, outpatient child psychiatry clinic, and day treatment programs. Trainees from several mental health disciplines participate in the program, including predoctoral psychology externs, interns from the Clinical Psychology Internship, residents from the Child Psychiatry Training Program, and postdoctoral research fellows in developmental psychopathology. Recently, the Infant Mental Health Program has also been able to offer its own training positions. The philosophical models of clinical service and training are outlined. The article concludes by looking at future directions and challenges for the Infant Mental Health Program. © 1997 Michigan Association for Infant Mental Health     

Demonstrating Support for the Formative and Summative Assessment Paradigm in a School-Based Intensive Mental Health Program

We illustrate the use of formative and summative assessment in evaluating a therapeutic classroom program for children with serious emotional disturbances. Information was analyzed based on data gathered for clinical decision-making during treatment (formative assessment) and measurement of outcomes at discharge (summative assessment) from a school-based Intensive Mental Health Program. Results indicated that overall ratings of daily indicators of behavior across all environments (therapeutic classroom, neighborhood school, and home) were predictive of functioning at discharge. An ecological approach during the formative assessment period of evaluation is important as compared to only examining individual environments. Formative assessment techniques can predict scores on a summative assessment measure. Thus, we found supportive evidence for the formative and summative procedures used in the Intensive Mental Health Program for therapeutic interventions, clinical decision-making, and outcomes assessment.     

Evaluation of the diagnostic interview for children and adolescents for use in general population samples

This article presents evaluative data on the use of the Diagnostic Interview for Children and AdolescentsRevised (DICAR) to classify DSM-IIIR disorders in the general population. Data for the analyses came from a probability sample (N=251) of parentchild/adolescent dyads aged 6 to 16 separately administered the DICAR on two occasions, 10 to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence,testretest reliability, parentchild/adolescent agreement, and trained lay interviewerchild psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6 to 11year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parentchild/adolescent dyads was generally low while agreement between trained lay interviewerschild psychiatrists was generally high.This work was supported by funds from the National Health Research and Development Program (grant number 6606-3760-42) and the Ontario Ministry of Community and Social Services, and was carried out by the Child Epidemiology Unit, Department of Psychiatry, McMaster University and the Child and Family Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario. Dr. Boyle is supported by a William T. Grant Foundation Faculty Scholar Award; Dr. Offord by a National Health Scientist Award, Health and Welfare Canada; Dr. Szatmari by a Research Fellowship, Ontario Mental Health Foundation; and Dr. Fleming by a NARSAD Young Investigator Award. The authors wish to thank the Hamilton Board of Education, particularly Mr. Keith Reilly and Mr. Owen Jackson; principals and teachers of the Board; and parents and students for their help on this project. Our appreciation also extends to Ms. Barb Hall who assisted in the analysis of the data.     

Confusions about context in the judgment of facial expression: A reply to “the contempt expression and the relativity thesis”

A recent study of the effect of context in the judgment of contempt facial expression (Russell, 1991) was flawed by several confusions about what constitutes context. We argue that the context used should have ecological validity, through the use of many, rather than a few, facial expressions, which are spontaneous rather than posed, and which are judged by carefully selected judgment tasks, using clearly defined or well-understood emotional terms. The confusion in Russell's work between accuracy studies and agreement studies is also addressed.Paul Ekman's work is supported by a Research Scientist Award from the National Institute of Mental Health (MH 06092). David Matsumoto's research is supported by a grant from the National Institute of Mental Health (MH 42749).     

The effect of dextroamphetamine on habituation of peripheral vascular response in children

The blood volume pulse (BVP) measured by a photoplethysmograph was recorded in 43 children with behavior and learning problems before and after either stimulant drug treatment or placebo. A series of twenty-four 750-cps tones was presented at 10-sec. intervals, with one trial having a doubled interval and one with a halved interval. A 1,000-cps tone was introduced following the 24th trial. As predicted, the drug-treated subjects showed significantly more rapid habituation to the tones. They also showed more variability of BVP following the longer intertriai interval, but showed less variability following the introduction of the high tone. The results are interpreted as showing that the stimulant has the effect of raising autonomie arousal level with consequently more rapid habituation of the orienting response.An earlier version of this article was presented to The Society for Psychophysiological Research, Monterey, California, October 1969. This research was supported by Grant No. MH14432 from the Psychopharmacology Section (National Institute of Mental Health) and Research Scientist Development Award No. K2MH7839 (National Institute of Mental Health).     

Family Protection and Prevention of Alcohol Use Among Hispanic Youth at High Risk

Research regarding prevention strategies for Hispanic youth stress the importance of family interventions because of the particular importance of family as a protective factor within the Hispanic community. Starting in 1995, the Center for Substance Abuse Prevention conducted the National Cross-Site Evaluation of High Risk Youth Programs, a 5-year drug and alcohol prevention study with a sample of approximately 10,500 youth, including nearly 3,000 Hispanic youth. Youth were surveyed regarding their alcohol use patterns and risk and protective factors, with several measures of family relationships, including family connectedness, family supervision, and parental attitudes toward their child's alcohol use. Analyses indicate that family factors are highly linked to alcohol use among Hispanics, particularly among Hispanic females. Longitudinal growth curve analyses indicate that improving the connections that young Hispanic females have to their parents can have positive long-term effects on delaying or reducing their alcohol use. This evaluation was conducted under the direction of Dr. Soledad Sambrano, Ph.D. of the Center for Substance Abuse Prevention under contract #2777-95-5002 with EMT Associates, Inc. and ORC Macro. The views expressed herein represent the opinions and analyses of the individual authors and may not necessarily reflect the opinions, official policy, or position of the U.S. Department of Health and Human Services, the Public Health Service, the Substance Abuse and Mental Health Service Administration, or the Center for Substance Abuse Prevention.     

Assessment of depression and diagnosis of depressive disorder among psychiatrically disturbed children

This study examined the relations between performance on alternative measures of childhood depression and diagnosis of depressive disorder. Hospitalized inpatient children (N=770, ages 7–13) with a diagnosis of depressive disorder (Research Diagnostic Criteria) were compared with a matched sample of patients whose diagnoses excluded depression. Children and parents completed four standardized depression scales plus measures designed to assess associated features including hopelessness, selfesteem, and internalizing symptoms. The results indicated that (1) alternative depression measures, whether completed by children or parents, yielded scores that were significantly higher for children with a diagnosis of depression; (2) parent ratings of severity of depression were consistently higher among the measures than the child ratings; (3) optimal cutoff scores derived for each measure correctly classified approximately 60% of depressed and nondepressed cases; (4) different cutoff scores were required for the same measure, depending on whether children or parents were the raters; and (5) using a battery of measures and combining these in a stepwise discriminant function yielded over 80% classification accuracy. The implications of the results for selection of cases for clinical research are discussed.Completion of this research was supported by a Research Scientist Development Award (MH00353) and by a Clinical Research Center Grant for the Study of Affective Disorders (MH30915) from the National Institute of Mental Health. The authors are grateful to members of the clinical research team of the Child Psychiatric Treatment Service, who greatly facilitated this research.     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

False recognition of static and dynamic object properties by preschool children

A false recognition task was used to compare preschool children's use of static and dynamic properties of objects in semantic processing. Four, five, and six year old children heard a list of object names, and then were tested for recognition of these words with a recognition test list that included distractor words that were static or dynamic properties of the objects on the first list. False recognition scores of dynamic properties were higher than those for static, for 4 and 5 year old children, with no differences for 6 year old children. The results argue for a functional basis for the encoding of referential terms in memory, and are discussed in terms of two models of semantic development.This research was partially supported by Department of Health, Education, and Welfare Research Service Award HD 07066 and U.S. Public Health Service Grant HD 00870 from the National Institute of Child Health and Human Development to the Kansas Center for Mental Retardation and Human Development.     

Severity of unipolar depression and choice of treatment.

The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (Elkin et al., Archives of General Psychiatry, 46, 971-982; 1989) reported treatment-by-severity interactions favouring pharmacotherapy for more depressed outpatients, on a minority of relevant comparisons. The present study reports secondary analyses from a similar, preexisting data set in which treatment-by-severity interactions are systematically investigated with depressed outpatients treated either with nondirective psychotherapy, behaviour therapy, pharmacotherapy, or relaxation/placebo. Despite multiple severity measures and variable severity cut scores, no treatment was differentially effective in improving more severely depressed patients. Also, there was little difference across symptom severity levels in the proportions of recovered patients between treatment groups. Finally, dynamic cluster analysis demonstrated that the proportion of pharmacotherapy nonresponders (20%) did not differ from the proportion of nonresponders in behaviour therapy or placebo groups. It is concluded that this failure to replicate the NIMH trial findings can not be attributed to treatment differences, populations or statistical power. The suggestion that pharmacotherapy be the treatment of choice for more severely depressed outpatients appears to be unjustified on the basis of available evidence.     

Vulnerability to depression: reexamining state dependence and relative stability

Treatment-related decreases in Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978) scores have been interpreted as evidence that dysfunctional attitudes are state-dependent concomitants of depression. Data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program were used to reexamine the stability of dysfunctional attitudes. Mean scores for Perfectionism, Need for Approval, and total DAS decreased after 16 weeks of treatment. However, test-retest correlations showed that the DAS variables displayed considerable relative stability. Structural equation models demonstrated that dysfunctional attitudes after treatment were significantly predicted by initial level of dysfunctional attitudes as well as by posttreatment depression. The relative stability of dysfunctional attitudes was even higher during the 18-month follow-up period. The results were consistent with Beck's (1967) and Blatt's (1974) theories of vulnerability.     

The Children's Firesetting Interview with psychiatrically referred and nonreferred children

This study evaluated the Children's Firesetting Interview (CFI). The measure was developed to operationalize multiple domains of functioning derived from a riskfactor model of firesetting. The model poses that child, parent, and family characteristics promote firesetting and continuation of a pattern of firesetting. Major factors include curiosity about fire, involvement in and exposure to firerelated activities, and knowledge about first safety The CFI, consisting of 46 questions reflecting six a prioridimensions, was administered to 519 children (ages 6–13) recruited from nonpatient, outpatient, and inpatient samples. Internal consistency and testretest reliability of the measure were satisfactory. Criterion validity was supported by the findings that firesetters showed greater curiosity about fire, involvement in firerelated activities, exposure to models/materials, and knowledge about things that burn than did nonfiresetters. These findings did not vary as a function of the child's patient status or level of antisocial behavior. Implications for the evaluation of firesetting risk are discussed.This study was supported by grant MH-39976 from the Antisocial and Violent Behavior Branch of the National Institute of Mental Health and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors acknowledge the constructive suggestions of two anonymous reviewers.     

The universality of a contempt expression: A replication

Two experiments replicated Ekman and Friesen's finding of an expression that signals contempt across cultures. The subjects, from West Sumatra, Indonesia, were members of a culture that differs in a number of ways from Western cultures. In one experiment the subjects judged photographs of Japanese and American faces, both males and females, which showed many different emotions. There was very high agreement about which expressions signaled contempt in preference to anger, disgust, happiness, sadness, fear, or surprise. In a second experiment the Indonesian subjects judged expressions shown by members of their own culture, and again there was very high agreement about which expression signals contempt.This study was supported by a grant from the National Institute of Mental Health (MH 41100). Paul Ekman's work is also supported by a Research Scientist Award from the National Institute of Mental Health (MH 06092). Karl G. Heider's work was supported by a grant from the National Institute of Mental Health (MH 38221). We are grateful to Maureen O'Sullivan for her many helpful comments on this report.