Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.     

Psychotropic Medication Management Within Residential Treatment Centers: Physician Opinions About Difficulties and Barriers

Research has shown that between 40 and 98 % of youth entering residential treatment are taking at least one psychotropic medication and that psychotropic medication management is often an integral component of treatment in residential settings. To determine physician opinion about the difficulty of managing psychotropic medications for youth in residential treatment and to determine the resources that are used in the process, a survey study was conducted. Overall, physicians indicated that youth involved in residential settings were much more complex than those in traditional outpatient settings, due to multiple mental health diagnoses, polypharmacy, and unknown treatment histories. They also reported that many existing resources are not applicable to youth, particularly those in residential settings, and that they are difficult to read and interpret.     

Integration of visuospatial information encoded from different viewpoints

Two experiments investigated whether separate sets of objects viewed in the same environment but from different views were encoded as a single integrated representation or maintained as distinct representations. Participants viewed two circular layouts of objects that were placed around them in a round (Experiment 1) or a square (Experiment 2) room and were later tested on perspective-taking trials requiring retrieval of either one layout (within-layout trials) or both layouts (between-layout trials). Results from Experiment 1 indicated that participants did not integrate the two layouts into a single representation. Imagined perspective taking was more efficient on within- than on between-layout trials. Furthermore, performance for within-layout trials was best from the perspective that each layout was studied. Results from Experiment 2 indicated that the stable environmental reference frame provided by the square room caused many, but not all, participants to integrate all locations within a common representation. Participants who integrated performed equally well for within-layout and between-layout judgments and also represented both layouts using a common reference frame. Overall, these findings highlight the flexibility of organizing information in spatial memory.     

On the importance of being first: Serial order effects in the interaction between action plans and ongoing actions

When we plan sequences of actions, we must hold some elements of the sequence in working memory (WM) while we execute others. Research shows that execution of an action can be delayed if it partly overlaps (vs. does not overlap) with another action plan maintained in WM (partial repetition cost). However, it is not known whether all features of the action maintained in WM interfere equally with current actions. Most serial models of memory and action assume that interference will be equal, because all action features in the sequence should be activated to an equal degree in parallel; others assume that action features earlier in the sequence will interfere more than those later in the sequence, because earlier features will be more active. Using a partial repetition paradigm, this study examined whether serial position of action features in action sequences maintained in WM have an influence on current actions. Two stimulus events occurred in a sequence, and participants planned and maintained an action sequence to the first event (action A) in WM while executing a speeded response to the second event (action B). Results showed delayed execution of action B when it matched the first feature in the action A sequence (partial repetition cost), but not when it matched the last feature. These findings suggest that serial order is represented in the action plan prior to response execution, consistent with models that assume that serial order is represented by a primacy gradient of parallel feature activation prior to action execution.     

THE DEVELOPMENT OF FALSE‐POSITIVE OUTCOMES DURING FUNCTIONAL ANALYSES OF PROBLEM BEHAVIOR

False‐positive outcomes of functional analyses exist when exposure to the consequences in a condition strengthens a relation that did not previously exist. Two functional analyses (aggression and spitting) were conducted with a child with an intellectual disability. High rates of problem behavior occurred immediately in the attention condition of the functional analysis across response topographies, suggesting a clear functional response class. However, rates of aggression and spitting increased in the demand condition, following the initial block of sessions, indicating the possible creation of a novel contingent relation for spitting. Copyright © 2014 John Wiley & Sons, Ltd.     

Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.     

Creating metacognitive environments in primary school RE classrooms

Recent reports on Religious Education (RE) in England and Wales highlight the need for guidance on pedagogy and learning. The RE-flect project addressed this by promoting the creation of metacognitively oriented learning environments in primary school RE classrooms. Six primary school teachers and 160 pupils (eight to 10 years of age) took part in the second year of this two year project. Meta-thinking, worldview and resources zones were created in each classroom. Attainment in RE and pupil perceptions of the learning environment were measured. Data from classroom observations, Worldview Profiles (WVP), and pupil and teacher interviews were analysed qualitatively. Results show an overall increase in attainment; a positive change in pupil perceptions of the learning environment; and the ability of pupils to reflect on and articulate their worldviews. Implications for RE curricular and pedagogy are discussed.