Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

The Contribution of Hope and Affectivity to Diabetes-Related Disability: An Exploratory Study

This study examined the relationships of the dispositional variables of hope, positive affectivity (PA), and negative affectivity (NA) with disease status and illness-related psychosocial functioning in a sample of 45 young adults with insulin-dependent diabetes mellitus (IDDM). Canonical analyses revealed one significant canonical function between the dispositional and psychosocial outcome variables. Primary contributors to the relationship were higher NA and lower PA and maladaptive emotional behavior. A linear multiple regression analysis using hope and affectivity as predictors failed to account for a significant proportion of variance in objective disease status as measured by hemoglobin A _1C (HbA_1C). The results support previous findings that affectivity may relate to self-reported, disease-related outcome, but not necessarily to objective measures of health status. Future studies of adaptation to chronic illness should consider including measures of illness-related behaviors (e.g., adherence), as well as subjective and objective measures of health status.     

REDUCTION OF SEVERE BEHAVIOR PROBLEMS IN THE COMMUNITY USING A MULTICOMPONENT TREATMENT APPROACH

Problem behavior often prevents community integration of people with developmental disabilities. Therefore, we evaluated a multicomponent approach for remediating problem behavior in public community settings (specifically, supermarkets). We selected treatments based on hypotheses about the variables controlling the problem behavior (hypothesis-driven model). The multicomponent intervention included choice making, embedding, functional communication training, building tolerance for delay of reinforcement, and presenting discriminative stimuli for nonproblem behavior. Treatment progress was monitored using measures of latency and task completion rather than traditional measures of frequency and time sampling. Results showed substantial increases in task completion and duration of time spent in supermarkets without problem behavior. Outcomes were socially validated by group-home staff and cashiers. We discuss how the intervention approach taken can resolve some of the issues involved in assessing, measuring, and treating problem behavior in the community.     

Gender differences in the correlates of preschoolers' behavior

This study is concerned with the nature of gender differences in 4-year-olds. In each of three replications, 18–21 girls and 20–22 boys (all white) were observed at home and school. Temperamental characteristics were assessed and (in one replication) a self-concept instrument was used. Gender differences in the frequencies of particular types of interaction were few and inconsistent across replications. There were, however, consistent gender differences in the correlations between characteristics and aspects of behavior. For instance, boys tended to be less consistent across situations in showing hostility, and to mix positive and negative interactions more, than girls. Mothers' use of Strong Control had different correlates in boys and girls. It is suggested that such differences in relations between measures may provide the raw material from which later gender differences develop.     

British parents' beliefs about the causes of three forms of childhood psychological disturbance

Parents were asked to rate which of 40 items were likely causes of one of three types of psychological disturbance common among 9-year-old children, the symptoms of which were outlined in vignettes. Parents' accounts were consistent and coherent. Symptoms of hyperactivity were linked to poor diet, antisocial conduct to a lack of discipline and unhappiness at school, and emotional problems to breakdowns in interpersonal relations and unhppiness at school. However, a number of factors (socioeconomic difficulties, attachment risks, and organic dysfunction) that research suggests are risks to development were rated by parents as unlikely causes of problems. The implications of this mismatch between lay and expert views is examined.We would like to thank Dr. Margaret Thompson for her clinical advice as well as the parents who took part in the study.     

Prosopagnosia: A face-specific disorder

A follow-up study of a patient, WJ, with a very severe prosopagnosia is reported. After a stroke he became a farmer and acquired a flock of sheep. He learnt to recognize and name many of his sheep, and his performance on tests of recognition memory and paired-associate learning for sheep was significantly better than on comparable tests using human face stimuli. It is concluded that in some instances prosopagnosia can be a face-specific disorder.     

DOES SLEEPTIGHT WORK? A BEHAVIORAL ANALYSIS OF THE EFFECTIVENESS OF SLEEPTIGHT FOR THE MANAGEMENT OF INFANT COLIC

We evaluated the effectiveness of SleepTight in the management of infant colic. SleepTight is a device that vibrates the infant's crib to simulate the action of a car traveling at 55 mph. A multiple baseline design across 6 infants was used. Data were collected on infant crying, parental use of SleepTight, and parental satisfaction. The application of SleepTight was associated with reduction in crying in 4 of the 6 infants. These outcome data notwithstanding, consideration of reported nonrecording of severe episodes and mixed reports of satisfaction suggests that SleepTight may not be a viable means of managing infant colic.     

Perceived control,causality, expectations and help-seeking behaviour

Undergraduates recruited from an introductory psychology course who were currently not seeking professional help (n=81) were compared with a comparable sample seeking professional help at a university psychological services centre (n=53). Participants answered an assessment instrument with reference to the problem currently upsetting them most. As hypothesized, those students seeking help tended to internalize causality, report lower levels of perceived control over their problems, and consider themselves more likely to expend time and energy in resolving their problem. Contrary to expectations, the groups did not differ in optimism about problem resolution. Results from an exploratory analysis of perceptions about the nature of professional and non-professional help are also reported. The findings, consistent with previous research, underscore the importance of differentiating the constructs of locus of control, causal attributions, and perceived control in studying mediators of help-seeking behaviour.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.