Intervallbehandlung statt disziplinarischer Entlassung

Background

Conduct disorder is a frequent mental health problem in children and adolescents characterized by high functional impairment and a poor prognosis. Different types of interventions have been established but only few have proven effective. Relevant effect sizes could only be shown for family centred interventions. Inpatient treatment is not the first line treatment even though children, adolescents and their families often present with a query for inpatient admission when outpatient resources are at their limits.

Aim

The effectiveness of a newly developed interval treatment for adolescents with conduct disorder, which focuses on motivation of the adolescent, involvement of the family in the therapy and the avoidance of disciplinary discharge, was evaluated.

Material and methods

A total of 19 adolescents aged between 16 and 18 years with conduct disorder was treated and assessed within the new interval treatment. The key symptoms of conduct disorder, sociodemographic data, psychosocial functioning (children global assessment of functioning scale, CGAS) as well as the severity of impairment of behavior (health of the nation outcome scales for children and adolescents, HoNOSCA) were recorded before treatment (T1). After completion of treatment (T2) the frequency of participation in the three possible treatment intervals, as well as psychosocial functioning and severity of impairment of behavior were documented.

Results

Interval treatment leads to a reduction of disciplinary discharges. Engagement in and motivation for treatment was enhanced. At the end of treatment a significant effect on psychosocial functioning, behavior and severity of symptoms could be shown for interval treatment.

Conclusion

Inpatient interval treatment for adolescents with conduct disorder is an innovative and effective concept, when outpatient treatment has reached its limits.     

Intramodal and crossmodal pairing and anchoring in comparisons of successive stimuli

Two experiments were conducted to study effects of modality, temporal position, and their interaction on comparisons of successive stimuli. In Experiment 1, intramodal (tone–tone and line–line) and crossmodal (tone–line and line–tone) stimulus pairs, with two interstimulus intervals (ISIs), 400 and 2,000 ms, were presented. Participants indicated which stimulus was the “stronger.” Time-order errors (TOEs) were assessed using the D% measure and were found in all types of pairs. Variation in TOEs across conditions was well accounted for by changes in parameters (stimulus weights, reference levels) in an extended version of Hellström’s sensation weighting (SW) model. With an ISI of 2,000 ms, the first stimulus had a lower weight (less impact on the response) than did the second stimulus. More negative TOEs were found with the longer ISI in all pair types except tone–line. In Experiment 2, participants indicated which of two lines was the longer or which of two tones was the louder. An intra- or crossmodal anchor, or no anchor, was interpolated between the stimuli. Anchoring tended to reduce the weight of the first stimulus, suggesting interference with memory, and to yield negative TOEs. Intramodal anchors yielded reduced weights of both stimuli, most dramatically for tones, suggesting an additional effect of stimulus interference. Response times decreased with crossmodal anchors. For line–line pairs, strong negative TOEs were found. In both experiments, the variation in TOE across conditions was well accounted for by the SW model.     

Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis

Comorbidity rates between ADHD and anxiety disorders (AD) are high, but little is known about the nature of this co-occurrence. A dominant idea is that AD may intensify some (i.e., attention and working memory) and attenuate other (i.e., inhibition) ADHD symptoms. Results are mixed, potentially because of between-study differences. To investigate this further we performed a meta-regression analysis on 11 studies (n ‘ADHD-only’ = 695; n ‘ADHD + AD’ = 608), containing 35 effect sizes on attention, inhibition and working memory. Main results were: (1) no evidence of a negative effect of AD on attention and working memory; (2) better response inhibition in children with ADHD with AD than those with only ADHD (medium ES g = ? .40); (3) medication moderated this association: the effect seemed limited to studies that included medication-naïve participants; (4) the difference between the two groups increased with age for attention and with proportion of boys for working memory ability. There was no effect of comorbid disruptive behavior disorder. In conclusion, AD seems to be a protective factor for inhibition problems as assessed with laboratory tasks in ADHD, especially in children who are medication naïve. Further, AD may have a protective function for attention in older children, and for working memory in boys with ADHD. It is therefore important to screen for AD when diagnosing ADHD, and to educate those with comorbid AD about the possible positive function of feeling anxious. Potential negative effects of ADHD medication on inhibition in children with comorbid AD should be considered.     

The eye of the retriever: developing episodic memory mechanisms in preverbal infants assessed through pupil dilation

Studying memory in infants can be challenging, as they cannot express their subjective recollection verbally. In this study we use a novel method with which we can assess episodic recognition memory through pupillometry, using identical procedures and stimuli for infants and adults. In three experiments of 4‐ and 7‐month‐old infants, and adults we show that the adult pupillary response is larger to previously seen than to never seen items (old/new effect). Pupil dilations index subjective memory experience in adults, producing distinct pupil dilations to items judged as remembered, familiar, and new, regardless of actual previous exposure (Experiment 1). Seven‐month‐old infants demonstrate a clear pupillary old/new effect, very similar to that of adults (Experiment 2), whereas 4‐month‐olds do not demonstrate such an effect (Experiment 3). Our findings suggest that the mnemonic mechanisms that serve infants' and adults' episodic recognition memory are more similar than previously asserted: they are not fully developed at 4 months of age but that there is contiguity in human episodic memory development from 7 months of age.     

Perceived sources and levels of stress,general self-efficacy and coping strategies in preclinical dental students

Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. ‘Exams and grades’ followed by ‘Fear of failing course or year’ were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were ‘Workload’ and ‘Social stressors’, respectively. ‘Social stressors’ affected male more than female (p < .05). The most and the least common coping strategies were found to be ‘Planning’, and ‘Drug’, respectively. Female used ‘Instrumental support’ more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.