Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid

System-wide research on the use of out-of-home care among children and youth is needed to inform the development of policies and services. We used Medicaid claims from North Carolina to examine patterns of out-of-home care, identify demographic and diagnostic differences between those who received care in residential treatment, psychiatric hospitals, or general hospitals, and determine whether demographic or diagnostic characteristics were associated with having more than one out-of-home stay during the year. Among those who received out-of-home care during a 1 year period, 36% received care in residential treatment only, 32.4% in general hospitals only, and 17.6% in psychiatric hospitals only, while 14.0% used more than one sector of out-of-home care. Boys, teenagers, and youth in foster care or diagnosed with emotional disturbance or hyperkinetic syndrome had higher odds of receiving care in residential treatment only whereas girls, youth age 19–21, and those with depressive and stress and adjustment disorders had higher odds of receiving care from hospitals only. Teenagers and youth in foster care had higher odds of having more than one stay. Among those with more than one stay, there were 300 patterns of care and nearly half received care from more than one service sector. The implications for services and policy are discussed. Further research is needed to understand patterns of out-of-home care and the factors that influence placement decisions.     

Neural and behavioral effects of interference resolution in depression and rumination

Individuals diagnosed with major depressive disorder (MDD) often ruminate about their depression and their life situations, impairing their concentration and performance on daily tasks. We examined whether rumination might be due to a deficit in the ability to expel negative information from short-term memory (STM), and fMRI was used to examine the neural structures involved in this ability. MDD and healthy control (HC) participants were tested using a directed-forgetting procedure in a short-term item recognition task. As predicted, MDD participants had more difficulty than did HCs in expelling negative, but not positive, words from STM. Overall, the neural networks involved in directed forgetting were similar for both groups, but the MDDs exhibited more spatial variability in activation in the left inferior frontal gyrus (a region critical for inhibiting irrelevant information), which may contribute to their relative inability to inhibit negative information.     

The historical context of G. Stanley Hall's Adolescence (1904)

G. Stanley Hall's magnum opus, Adolescence, published in 1904 in two hefty volumes I herein submit to historical analysis. I am concerned with how it did "fit" into the notions and practices of the larger culture as well as into the discourses of science and of child nurture of that time. There is plenty of evidence of Hall's ethnic, racial, and gender attitudes as expressed in the book being typical of the white, Anglo-Saxon Protestant middle class stratum to which he belonged. His discussions of the extant discourses of science and of child nurture show a man quite conversant with these discourses, and not merely in American and British, but also in French and German publications as well. Probably any book, idea, or historical circumstance or phenomenon is chiefly a historical artifact, and we should not bend it much to "prove" that it is in any important sense a part of a different age. It is one thing to say that a certain idea has a contemporary resonance; to claim there is a straight line from it to today is problematic and meaningless.     

Fear information and social phobic beliefs in children: a prospective paradigm and preliminary results

This paper presents a first attempt to develop a prospective paradigm to test Rachman's (Behav. Res. Ther. 15 (1977) 375) theory of fear acquisition for social fears. Following the prospective paradigm for animal fears developed by Field et al. (Behav. Res. Ther. 39 (2001) 1259) an attempt is made to adapt this paradigm to look at the effect of fear information in the development of social fears. A large group of normal children (N=135) who were at an age (10-13 years) at which social concerns are most pertinent were tested using this paradigm. They were given positive, negative or neutral information about three social situations: public speaking, eating in public, and meeting a new group of children. Children's fear beliefs were measured before and after the information was given and the information was given by a teacher, a same age peer or no information was given (a control). The results indicate that although information can change social fear beliefs it is dependent upon the type of social activity and who provides the information. The implications of these initial results for our understanding of both the role of fear information in the development of social fear beliefs, and the limitations of this current paradigm are discussed.     

Family-expressed emotion,childhood-onset depression,and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to express their appreciation to Sybil Zaden and Ana Magana-Amato for their assistance coding the FMSS-EE data, to Gwen Gordon for her assistance with data analysis, and to the families participating in the project.     

Further evidence for meaning change in impression formation

Hamilton and Zanna (Journal of Personality and Social Psychology, 1974, 29, 649–654) demonstrated that the meaning of an attribute as rated on connotatively related scales changed as a function of context desirability. This finding was viewed as supporting a meaning change interpretation of context effects in impression formation. Kaplan (Memory and Cognition, 1975, 3, 375–380, Exp. 1) found that similar changes also occurred on scales unrelated in meaning to the test attribute and argued that changes on both kinds of scales were due to halo effects produced by the contexts. Controlling for possible scaling artifacts, the first experiment reported here showed that substantially greater changes occurred on related than on unrelated scales. Kaplan (1975, Exp. 2) also found that the magnitude of context-induced differences in judgments of trait likability was not increased by creating contexts denotatively related to the test attributes. Adding measures of connotative meaning, the second experiment in this paper showed that substantially greater context-induced changes did occur on related meaning scales and, in contrast to Kaplan, on trait likability for the denotatively related contexts. The results of each experiment are consistent with a meaning change position but would not be expected on the basis of the halo effects model.     

A THERMODYNAMIC THEORY OF THE ORIGIN AND HIERARCHICAL EVOLUTION OF LIVING SYSTEMS

Growing interest in the origin of life, the physical foundations of biological theory, and the evolution of animal social systems has led to increasing efforts to understand the processes by which elements or living systems at one level of organizational complexity combine to form stable systems of higher order. J. Bronowski saw the need to extend or reformulate evolutionary theory to deal with the hierarchy problem and to account for the evolution of systems of “stratified stability.” The hierarchy problem has become a matter of great interest also in nonequilibrium thermodynamic theory. An effort is made here to develop an abstract, phenomenological model, based on the laws of thermodynamics, to account for the origin and hierarchical evolution of living systems. It is argued that the principle of minimum entropy production, developed by I. Prigogine, applies generally to all thermodynamic systems and processes and is implicit in an extended and more complete formulation of the second law of thermodynamics. From this are derived a thermodynamic criterion and a principle of thermodynamic selection governing the formation of stable systems of “elements” of various levels of organization. Thermodynamic selection gives rise to the creation of “elements” having increasingly “open” characteristic structures which may combine spontaneously to form “social” or crystalline systems capable of growing and reproducing themselves through processes of fissioning or budding. Such simple, self-reproducing systems are capable of evolving by natural selection, which is seen to be a special case of the more general process of thermodynamic selection. The principle of natural selection, thus formulated, has the character of a fundamental physical law. Self-reproducing systems with suitably open hereditary programs may combine to form stable social systems, which may grow and reproduce as a unit. In this way self-reproducing systems of increasing hierarchical order, size, and organizational complexity may evolve through processes of thermodynamic (natural) selection. Some implications of this open-ended model and opportunities for testing its empirical and theoretical utility are explored.     

Nietzsche on Nobility and the Affirmation of Life

In this paper I explore Nietzsche's thinking on the notions of nobility and the affirmation of life and I subject his reflections on these to criticism. I argue that we can find at least two understandings of these notions in Nietzsche's work which I call a 'worldly' and an 'inward' conception and I explain what I mean by each of these. Drawing on Homer and Dostoyevsky, the work of both of whom was crucial for Nietzsche in developing and exploring his notion of worldly nobility and affirmation, I then go on to argue that Nietzsche provides us with no concrete examples of worldly nobles and that, given his historicism, he cannot. Thus Nietzsche's thinking here is broken-backed. I turn, therefore, to explore the inward notions of nobility and affirmation. Discussing Montaigne and Napoleon in the context of Nietzsche's philosophy, I argue that we can make good sense in Nietzschean terms of someone's affirming his own life in an inward sense. This, however, opens up the difference between someone's affirming his own life and his affirming life überhaupt, and I argue that Nietzsche needs to be able to make sense not just of the former but also of the latter. Referring once again to Dostoyevsky, I suggest that Nietzsche can only do so by accepting the idea that all human beings possess dignity qua human beings. This thought is, however, one that he rejects. Thus Nietzsche's reflections in this area cannot be rendered finally plausible since they depend upon something which can find no room in his philosophy.