Learning to sleep through the night: Solution or strain for mothers and young children?

Is the process of helping infants and young children learn to sleep through the night a solution to family sleep problems or does it exacerbate matters for mother and child? Retrospective and current accounts from a nonclinical, convenience sample of 102 mothers of preschool‐aged children provided information on sleep issues from early infancy through preschool age. Child, mother, and parenting characteristics, along with family sleep arrangements, were differentially related to the age at which children learned to sleep through the night and to the extent of difficulty that characterized this experience. Mothers who indicated more difficulty as their children learned to sleep through the night also reported more depressive symptoms and more strain in the mother–child relationship. Later age at sleeping through the night was more common among early bedsharers, but timing of sleeping through the night was not associated with preschool children's reported independence in several nonsleep domains. Sleep arrangements and the importance placed on sleeping through the night were the strongest contributors to variance explained in whether children learned to sleep through the night during infancy or toddlerhood. When advising parents about sleep interventions, practitioners should seek to understand whether families' parenting values fit their nighttime sleep practices.     

Identifying Youth at Risk for Treatment Failure in Outpatient Community Mental Health Services

We developed predicted change trajectories and a warning system designed to identify psychotherapy cases at risk for treatment failure as observed in archival Youth Outcome Questionnaire data (parent/guardian-report) from 363 children and adolescents (ages 4–17) served in an outpatient community mental health system. We used multilevel modeling procedures to develop models of predicted change based on demographic information. Controlling for the effects of age on intercept, no other variables were significant in the model. The warning system we created from half of the sample (n = 181) correctly identified 71% of treatment failures in the other half of the sample (n = 182), defined as cases whose symptoms were significantly higher at the end of treatment compared to symptoms at intake. As over half of youth cases in this usual care setting did not demonstrate reliable improvement in symptoms, these results further emphasize the value of patient-focused research in monitoring patient progress and prompting changes in the treatment approach if suitable progress is not observed.     

The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.     

Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT psychotherapy initially. Although effective, symptom remission with medication alone is rare (e.g., only 21.4% of youth achieved remission with sertraline in the Pediatric OCD Treatment Study, 2004) and residual symptoms often remain (e.g., 58% of subjects in the March et al. [1998] sertraline trial were not considered treatment responders). This paper reviews the literature on the efficacy of CBT for pediatric OCD, particularly as it relates to the treatment of youth with prior inadequate response to medication. It also describes an intensive, family-based CBT program for children and adolescents with OCD and support for its efficacy among those with prior partial- or nonresponse to medication. Finally, we present a case study of an adolescent girl with OCD who participated in the intensive treatment program after having limited benefit from medication and non-CBT psychotherapy and experienced a favorable response.     

The aftermath of 9/11: effect of intensity and recency of trauma on outcome

Does trauma exposure have a long-term impact on the brain and behavior of healthy individuals? The authors used functional magnetic resonance imaging to assess the impact of proximity to the disaster of September 11, 2001, on amygdala function in 22 healthy adults. More than three years after the terrorist attacks, bilateral amygdala activity in response to viewing fearful faces compared to calm ones was higher in people who were within 1.5 miles of the World Trade Center on 9/11, relative to those who were living more than 200 miles away (all were living in the New York metropolitan area at time of scan). This activity mediated the relationship between group status and current symptoms of posttraumatic stress disorder. In turn, the effect of group status on both amygdala activation (fearful vs. calm faces) and current symptoms was statistically explained by time since worst trauma in lifetime and intensity of worst trauma, as indicated by reported symptoms at time of the trauma. These data are consistent with a model of heightened amygdala reactivity following high-intensity trauma exposure, with relatively slow recovery.     

Parents as moderators of psychological and physiological correlates of inner-city children's exposure to violence

This paper discusses the psychological and physiological correlates of inner-city violence on children, and the potential mediating and moderating roles of parents. Data are based on interviews regarding exposure to community violence (ECV), parenting practices, child distress, posttraumatic symptomology, and competence. Cardiovascular activation was also measured. Community violence exposure related to distress, posttraumatic symptomology, and incompetence. Harsh parenting related to aggression, distress, incompetence, and higher heart rates. Parenting moderated but did not mediate the effects of violence on measures of competence. High violence plus harsh parenting predicted lower levels of systolic (SBP) and diastolic blood pressure (DBP). Results are discussed within an ecological framework of parent–child relations and as they relate to the conclusion that children undergoing dual levels of stress may experience a dissociative response.     

Referral Source Differences in Functional Impairment Levels for Children Served in the Comprehensive Community Mental Health Services for Children and Their Families Program

We report one of the first multi-site investigations into referral source variation in functional impairment for children with serious emotional disturbance served in systems of care settings. Baseline data collected as part of the national evaluation for the Comprehensive Community Mental Health Services for Children and Their Families Program was used to assess the comparability of functional status for children referred from traditional mental health versus non-mental health agencies. Results indicate that children referred from child welfare and family groups have significantly lower levels of overall dysfunction than those referred from mental health, while children referred from school and juvenile justice agencies have comparable levels. Clinical and research implications are discussed.     

The Use of Standard Parenting Management Training in Addressing Disruptive Mood Dysregulation Disorder: A Pilot Study

Journal of Contemporary Psychotherapy - Parent management training has demonstrated effectiveness in the treatment of child behavioural issues and associated conduct difficulties. Anger,...