Introduction: novel therapies in developmental disabilities--hope, reason, and evidence

Complementary and alternative medicine (CAM) is used both alongside (complementary) and as a substitute for (alternative) conventional therapies. Although CAM use is reported to be high among children with typical development, reported rates for CAM use to address symptoms of children with developmental disabilities may be higher. Increased use in this population may relate to hope for amelioration of symptoms, concerns regarding side effects of conventional treatments, and a need on the part of families to participate in decision making regarding their child's care. Primary health care providers may find that the child's needs are best served when they maintain a dialogue with families to evaluate the evidence supporting novel therapies. Interventions need to be assessed in an evidence based fashion whether or not they are initially preceived as CAM. This issue of Mental Retardation and Developmental Disabilities Research Reviews contains reviews of CAM used to treat several developmental disabilities as well as some broader discussions related to the determinants of CAM use, current efforts to evaluate novel therapies, and how to consider the possibility of placebo effects.     

Comorbidity of Conduct and Depressive Problems at Sixth Grade: Substance Use Outcomes Across Adolescence

The comorbidity of conduct and depressive problems and substance use outcomes were examined in a community-based sample of 340 African American males and females. Alcohol, tobacco, and marijuana use were examined at Grades 6, 8, and 10 based on the following group membership at sixth grade: (a) comorbid conduct and depressive problems; (b) conduct problems only; (c) depressive problems only; (d) neither conduct nor depressive problems. Overall, the two conduct problem groups displayed the highest levels of substance use, although at some time points, comorbid youth displayed significant higher substance use levels. Subjects with depressive problems only displayed levels of substance use that were equivalent to subjects in the nonproblem group. Results highlight the importance of controlling for comorbid symptoms, possible interactive effects between conduct and depressive problems, and implications for treatment and prevention of substance use.     

Family Support and Conflict: Prospective Relations to Adolescent Depression

The relations between family support, family conflict, and adolescent depressive symptomatology were examined longitudinally in a sample of 231 female and 189 male adolescents and their mothers. Structural equation models revealed that less supportive and more con-flictual family environments were associated with greater depressive symptomatology both concurrently and prospectively over a 1-year period. Conversely, adolescent depressive symptomatology did not predict deterioration in family relationships. Depressive symptomatology and, to a greater extent, family characteristics showed high levels of stability over the 1-year period. Counter to our expectations, the relations between family variables and depressive symptomatology were similar for boys and girls. The results suggest that the quality of family interactions is relevant for understanding the development of depressive symptoms in adolescents.     

OVERCORRECTION: GENERALIZATION AND MAINTENANCE1

The present study examined the effects of one component of overcorrection—verbal reprimands—and compared them with the effects of the entire overcorrection procedure. Generalization and maintenance of effects were also evaluated. A combined reversal and multiple-baseline experimental design was used to evaluate the effect of the various contingencies on the inappropriate searching behavior of a severely and profoundly mentally retarded adult living in a group home. Searching was defined as carefully and thoroughly touching floors, sofas, cabinets, etc. Data were collected by group-home personnel during three separate observation periods each day of the 115-day study: before breakfast, after breakfast, and after dinner. Observers also served as experimenters. Following an initial baseline phase, verbal reprimands followed searching behavior during two daily experimental periods in multiple-baseline fashion. An immediate reduction of searching during experimental periods occurred with the onset of verbal reprimands. No reduction was observed in the third daily observation period, the control session. After a second baseline phase, during which searching behavior was not shown to return to the original baseline levels, overcorrection procedures (washing hands) were instituted. Overcorrection virtually eliminated inappropriate searching during both daily experimental periods. Further, the effects generalized to the daily control session. In a final experimental phase, decreased searching behavior was maintained with verbal reprimands alone.     

Effects of Bodily Contact on Reactions to Crowding1

The present study examined the effects of bodily contact in a crowded environment. Initially, the skin conductance levels (SCL) of 160 males and females were obtained during rest and while bursting a balloon. In a subsequent session, subjects in same-sex groups of four were seated for 30 minutes in either (a) a large room, (b) a small room subjected to unavoidable bodily contact, or (c) a small room which was partitioned to either reduce or prevent bodily contact while allowing visual access. Measures of mood, tolerance for frustration, cognitive task performance, and self reports of annoyance and somatic distress were then taken. Results showed that crowding is stressful and that bodily contact makes a significant contribution to the amount of stress experienced for both men and women. In general, crowded subjects forced to touch showed the greatest increases in SCL, felt most annoyed, were most bothered by spatial intrusion during crowding, and had the lowest tolerance for frustration following crowding. Sex differences in mood following crowding and in reaction to the noncrowded environment were observed and appeared to be mediated by differential social concerns.     

EFFECTS OF RELAXATION TRAINING ON PULMONARY MECHANICS IN CHILDREN WITH ASTHMA1

An experiment, designed to overcome shortcomings in previous work, was conducted to investigate the potential symptomatic benefits of relaxation training in the treatment of asthma in children. Fourteen chronic, severely asthmatic children received three sessions in which they rested quietly, followed by five sessions of relaxation training, and finally three sessions of relaxing as trained previously. Pulmonary function was assessed, in a manner far more definitive than in previous studies, before and after each session, and three additional times at 30-minute intervals thereafter. Tension in the frontales muscles, heart and respiration rates, and skin temperature and conductance were also monitored. Heart rate and to some extent muscle tension results tended to confirm the attainment of relaxed states. However, the lung function results failed to substantiate the previous, preliminary findings of a clinically meaningful change in pulmonary function following relaxation. The status of relaxation in the treatment of asthma was discussed.     

Multitrait-multimethod model of adolescent deviance,drug use,academic, and sexual behaviors

A multitrait-multimethod design was used to test Jessor and Jessor's (1977) problem behavior theory with a sample of adolescents, their parents, and peers. Behaviors included general deviance, drug use, low academic motivation, and precocious sexual behavior. While research has supported this theory, the reliance on self-report data for the majority of this work may threaten the validity of these findings. Results from hierarchical confirmatory factor analyses indicated that the convergent and discriminant validity of the seven behavior constructs was high and method effects were low. A two-factor second-order model, representing General Drug Use and Other Problem Behavior, accounted for a larger proportion of variance in the lower order factors compared to a single-factor model.This research was supported by Grant DA 03706 from the National Institute on Drug Abuse.