Transforming mental health care for children and their families

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed.     

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual.     

Implementation of a comprehensive schoolwide behavioral intervention: The ABC program

The Academic and Behavioral Competencies (ABC) Program, a schoolwide program to reduce classroom disruption and encourage rule following, academic task completion, and homework completion, is described. The program was initially developed and implemented in an elementary school with a high-risk population. Data from teachers, parents, and children indicate high levels of satisfaction with the program. In addition, unobtrusive measures of program impact, reported as reductions in referrals to the principal's office, suspensions, and increases in homework completion rates relative to the year prior to implementation of the program, suggest a preliminary positive impact of the program. A replication is reported for another school district, with teacher evaluations of satisfaction and effectiveness reported, supporting the flexibility and adaptability of the program. Although the present article does not constitute a systematic evaluation of the ABC Program, it presents preliminary data on the process of implementation and stakeholder satisfaction.     

A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.     

A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls

Recent studies have examined the prevalence of disordered eating and other health risk behaviors among adolescent boys and girls. However, these studies generally have not examined predictors of these behaviors, and have not embedded the investigations within a theoretical framework. This study employed a longitudinal design to evaluate the validity of a biosocial model in explaining health risk behaviors related to extreme body change strategies (disordered eating, exercise dependence, use of food supplements, steroid use) among adolescents. The participants were 430 adolescent boys (mean age = 13.33 years) and 451 adolescent girls (mean age = 13.28 years) who completed measures of pubertal timing, perceived popularity with peers, body dissatisfaction, focus on sport, involvement in competitive sport, strategies to lose weight, strategies to increase muscle, disordered eating, use of food supplements and steroids, and exercise dependence. It was found that both early and late maturing girls were at greatest risk of engaging in health risk behaviors, whereas boys demonstrated more variability in the relationship between pubertal timing and extreme body change behaviors. The results of this study provide important insights into the role of pubertal development in the adoption of extreme body change behaviors among adolescents.     

Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Cambodian refugees with posttraumatic stress disorder (PTSD) represent a cohort in severe need of treatment, but little information is available to guide treatment choices. We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy (CBT) for treating PTSD. Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22-26 years during the Pol Pot period (1975-1979). These patients were randomly assigned to either sertraline alone or combined treatment. We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms. Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD, and that a program of CBT emphasizing information, exposure, and cognitive-restructuring can be successfully modified for Khmer-speaking refugees.     

Promoting responsible conduct in research through “survival skills” workshops: Some mentoring is best done in a crowd

For graduate students to succeed as professionals, they must develop a set of general "survival skills". These include writing research articles, making oral presentations, obtaining employment and funding, supervising, and teaching. Traditionally, graduate programs have offered little training in many of these skills. Our educational model provides individuals with formal instruction in each area, including their ethical dimensions. Infusion of research ethics throughout a professional skills curriculum helps to emphasize that responsible conduct is integral to succeeding as a researcher. It also leads to the consideration of ethical dimensions of professional life not covered in traditional ethics courses.     

Does the body image exist in three dimensions? The study of visual mental representation of a body and a nonbody object

Do the mental images of 3-dimensional objects recreate the depth characteristics of the original objects? This investigation of the characteristics of mental images utilized a novel boundary-detection task that required participants to relate a pair of crosses to the boundary of an image mentally projected onto a computer screen. 48 female participants with body attitudes within expected normal range were asked to image their own body and a familiar object from the front and the side. When the visual mental image was derived purely from long-term memory, accuracy was better than chance for the front (64%) and side (63%) of the body and also for the front (55%) and side (68%) of the familiar nonbody object. This suggests that mental images containing depth and spatial information may be generated from information held in long-term memory. Pictorial exposure to views of the front or side of the objects was used to investigate the representations from which this 3-dimensional shape and size information is derived. The results are discussed in terms of three possible representational formats and argue that a front-view 2 1/2-dimensional representation mediates the transfer of information from long-term memory when depth information about the body is required.     

Parental divorce during adolescence and adjustment in early adulthood

The present study examined the impact of parental divorce during adolescence, interparental conflict, and intimacy with parents on young adult adjustment. One hundred sixty-seven undergraduate students (146 females, 21 males) completed a questionnaire regarding their psychosocial adjustment, their present relationships with their parents, the level of interparental conflict experienced during adolescence, and the marital status of their parents during adolescence. High levels of interparental conflict were found to be negatively associated with adjustment and current intimacy with parents. A poor relationship with both parents was negatively associated with several domains of psychosocial adjustment, while high intimacy with at least one parent was positively associated with adjustment. Intimacy with mother and with father were found to be the most important predictors of psychosocial adjustment. This investigation highlights the importance of maintaining a good parent-young adult relationship, particularly in divorced families. The findings indicate that future research should examine multiple family variables when assessing the impact of parental divorce or conflict on young adult adjustment.