Family Therapy in Outdoor Behavioral Healthcare: Current Practices and Future Possibilities

This paper highlights the role of the family in the treatment of youth who attend Outdoor Behavioral Healthcare (OBH) programs. It discusses the history of OBH, provides a critical overview of the research on the impact of OBH programs on family functioning, and discusses the importance of increased intentional integration of family therapy into OBH settings. To show this integration, this study presents a case study that highlights the role of the family, as well as the home family therapist throughout the phase of OBH treatment. Areas for future esearch are provided as well as suggestions for the increased utilization of adventure activities with families.     

Improving reading and self-concept through communication and social skills training

A course of psychological education is described in which disruptive children were taught social and communication skills over two terms. The course was designed for 26 eight-year-olds in an EPA junior school. Ten of the children were from broken homes, six were itinerants, most had displayed undesirable behaviour, and their level of achievement had been below average. Tested at the end of the second term, they showed dramatic improvements in self-concept and reading ability.     

A contingency management technique for increasing student attention in a small group setting

Fifty-four elementary school children previously identified as consistently inattentive were involved in an extraclassroom treatment program comparing three conditions. In the E condition, attention was reinforced by making the earning of token points (exchangeable for rewards) contigent upon appropriate responses to a signal detection task embedded in the lessons. C1 condition subjects participated in the same lessons without the token system, while C2 subjects remained in their regular classrooms throughout the study. Four participating classroom teachers received brief training in behavior modification techniques for maintaining student attention. Subjects in the E condition were found to be significantly more attentive during the treatment lessons. Changes did not transfer to the regular classroom, however, and training for teachers did not affect in-class attention scores of subjects.     

Investigating biases in trainee counsellors' attitudes to clients from different cultures

Two studies were conducted to explore the assumption that trainee counsellors who are members of the indigenous population will exhibit biased attitudes when they are confronted with the case-history of clients from other ethnic groups. Dependent measures included a structured methodology and free-response methods. This evidence indicates that respondents showed more favourable patterns of attribution for White clients than for clients from three other ethnic groups (Asian, Jewish and West Indian). There appeared to be discrimination in the biased attributions for particular out-group clients.     

Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent–Child Relationships Compensate?

Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent–child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n?=?1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual’s classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent–child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent–child relationships. This highlights the importance of considering the quality of friendships and parent–child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.

     

Attitudes and Practices Among Internists Concerning Genetic Testing

Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8 %), followed by Breast/Ovarian Cancer (15.0 %). In the past 6 months, 65 % had counseled patients on genetic issues, 44 % had ordered genetic tests, 38.5 % had referred patients to a genetic counselor or geneticist, and 27.5 % had received ads from commercial labs for genetic testing. Only 4.5 % had tried to hide or disguise genetic information, and <2 % have had patients report genetic discrimination. Only 53.4 % knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7 %) and guidelines for genetic testing (87.1 %). Most felt needs for more training on when to order tests (79 %), and how to counsel patients (82 %), interpret results (77.3 %), and maintain privacy (80.6 %). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p?<?.001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p?<?.002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p?<?.019), counseled patients about genetics, larger practices (p?<?.032), fewer African-American patients (p?<?.027), and patients who had reported genetic discrimination (p?<?.044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests. These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education.