Psychiatric diagnoses of infants and toddlers referred to a community mental health system

There has been increased interest in improving mental health assessment and treatment of young children. However, there are limited data regarding the prevalence of psychiatric disorders among infants and toddlers. The recent development of measures and classification systems that are specific to this age group has enabled researchers to begin to investigate the social, emotional, and behavioral problems of young children. The present study reviews the major research that has been conducted in this area and examines the prevalence of psychiatric diagnoses of infants and toddlers referred to a public community mental health system. The current investigation also compares the frequency of diagnoses of children who have been evaluated based on the Diagnostic and Statistical Manual (4th edition) with another group of children who were diagnosed based on the Diagnostic Classification: 0-3 system. Although there were some differences between the two samples and classification systems, analysis indicated that parent-child relational problems, adjustment difficulties, regulatory problems, and developmental disorders are some of the more common diagnoses prevalent among young children referred for outpatient treatment. As diagnostic measures and classification systems continue to improve, clinicians will have a better understanding of the mental health problems and treatment needs of young children.     

Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures

We examined 9-month data from the 14-month NIMH Multimodal Treatment Study of Children with ADHD (the MTA) as a further check on the relative effect of medication (MedMgt) and behavioral treatment (Beh) for attention-deficit/hyperactivity disorder (ADHD) while Beh was still being delivered at greater intensity than at 14-month endpoint, and conversely as a check on the efficacy of the MTA behavioral generalization/maintenance procedures. Intention-to-treat analysis at 9 months showed essentially the same results as at 14 months, after Beh had been completely faded; MedMgt and the combination (Comb) of medication and Beh were significantly superior to Beh and community care (CC) for ADHD and oppositional-defiant (ODD) symptoms, with mixed results for social skills and internalizing symptoms. All treatment-group differences examined as changes in slopes from 9 to 14 months were nonsignificant (we found general improvement for all groups). Slopes from baseline to 9 months correlated highly (r > .74, p < .0001) with slopes from baseline to 14 months for all groups. The time function from baseline to 14 months showed a significant linear, but not quadratic, trend for the main outcome measure (a composite of parent- and teacher-rated ADHD and ODD symptoms) for all groups. Findings suggest that in contrast to the hypothesized deterioration in the relative benefit of Beh between 9 and 14 months (after completion of fading), the MTA Beh generalization and maintenance procedures implemented through 9 months apparently yielded continuing improvement through 14 months, with preservation of the relative position of Beh compared to other treatment strategies.     

Girls Try,Boys Aim High: Exposing Difference in Implied Ability,Activity, and Agency of Girls Versus Boys in Language on McDonald’s Happy Meal Boxes

The present research investigates subtle yet powerful differences in the language present on cultural artifacts marketed for girls and boys. Through a content analysis of the verbs written on the girl-oriented and boy-oriented sides of all 56 McDonald’s Happy Meal boxes distributed between 2011 and 2019 in the United States, I uncover stark differences in the implied ability, activity, and agency levels of boys versus girls. The mixed methods nature of my exploration allows for statistical testing coupled with analysis of the language in context, revealing pervasive, nuanced differences that bolster our understanding of the complexity of the messages being relayed to children about what is appropriate and expected for boys versus girls. Central findings include the subtle, yet pervasive implication that girls are less active, less powerful, and in need of more detailed instruction and help, and they draw on a narrower set of skills as compared to boys. Through differential language, boys are also challenged at a qualitatively different level than girls and are assumed to have greater levels of ability (e.g., girls “try” and boys “aim high”). Girls’ agency is directly questioned, implying a lack of general confidence in the child’s ability to succeed, which is not the case for boys. Such subtle messages perpetuate insidious gender stereotypes and reinforce inequities in power and privilege.

     

Therapist Behavior During Exposure Tasks Predicts Habituation and Clinical Outcome in Three Randomized Controlled Trials for Pediatric OCD

This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive-compulsive disorder (POTS trials). Within exposure tasks, therapist behaviors and patient fear were coded continuously. Outcomes were habituation and posttreatment change in symptom severity, global improvement, and treatment response. More therapist behaviors that encourage approach—and less use of accommodation, unrelated talk, and externalizing language—predicted greater subsequent habituation during individual exposure tasks (exposure-level), and also predicted improved patient clinical outcomes via higher “total dose” of habituation across treatment (patient-level indirect effect). For six of seven therapist behaviors analyzed, the relationship with subsequent habituation within exposure differed by patient fear (low, moderate, or high) at the time the behavior was used. Two therapist behaviors had direct effects in the opposite direction expected; more unrelated talk and less intensifying were associated with greater patient symptom reduction. Results shed light on the “black box” of in-session exposure activities and point to specific therapist behaviors that may be important for clinical outcomes. These behaviors might be best understood in the context of changing patient fear during exposure tasks. Future studies should test whether therapist behaviors can be experimentally manipulated to produce improvement in clinical outcomes.     

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; M_age?=?19.53, SD?=?3.16, Range?=?18–45) who completed self-report measures for course credit.

Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.     

Differential Effects of Child Difficulties on Family Burdens across Diagnostic Groups

Children with neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), have a variety of difficulties that can place considerable strain on their families. This study investigated the nature of family burdens (i.e., financial burden, need for respite, need for counseling, work changes, and care hours) by examining the effects of child characteristics (i.e., age, gender, and severity of condition), family characteristics (i.e., parent role, education, income, and number of children), and child difficulties (i.e., behavioral, adaptive, emotional, social, learning, and communicative). With representative survey data from parents of children with ADHD (n?=?8252), ASD (n?=?1448), or ID (n?=?949), ranging in age from 2 to 17 years old, we used Χ ², binary logistic regression, linear regression, and univariate analyses to answer our research questions. We found that parents of children with ADHD, ASD, and ID experienced different types and amounts of burdens, families of younger children experienced more burden than those of older children, and families with more income or more children experienced fewer burdens. Adaptive and behavioral difficulties had the greatest relative impact on families. Diagnosis moderated almost all of the relationships between child difficulties and family burden. Overall, these results suggest that providing services and supports that are tailored to the specific needs of each child and family will be necessary for enhancing quality of life.     

Situation selection is a particularly effective emotion regulation strategy for people who need help regulating their emotions

Situation selection involves choosing situations based on their likely emotional impact and may be less cognitively taxing or challenging to implement compared to other strategies for regulating emotion, which require people to regulate their emotions “in the moment”; we thus predicted that individuals who chronically experience intense emotions or who are not particularly competent at employing other emotion regulation strategies would be especially likely to benefit from situation selection. Consistent with this idea, we found that the use of situation selection interacted with individual differences in emotional reactivity and competence at emotion regulation to predict emotional outcomes in both a correlational (Study 1; N?=?301) and an experimental field study (Study 2; N?=?125). Taken together, the findings suggest that situation selection is an effective strategy for regulating emotions, especially for individuals who otherwise struggle to do so.     

Implicit alcohol and smoking associations among young adult heavy drinkers: Associations with smoking status and alcohol-cigarette co-use

Implicit memory associations may play a role in motivation to use alcohol and cigarettes, but the relationship between implicit associations and co-use of alcohol and cigarettes is currently unknown. This study provided an initial examination of alcohol and smoking implicit associations among young adult drinkers who were either nonsmokers or relatively light smokers (i.e., 10 or fewer cigarettes per day) as a function of smoking frequency and daily-level alcohol-cigarette co-use. Drinkers (n?=?129) completed alcohol-arousal and smoking-valence variants of the implicit association test as well as a daily-level assessment of past 90-day alcohol and cigarette use. Smokers were grouped according to whether they reported daily or nondaily smoking frequency. Results showed that although implicit alcohol-arousal associations did not differ between smokers and nonsmokers, stronger implicit alcohol-arousal associations were observed for nondaily smokers relative to daily smokers after controlling for drinking frequency. Further, implicit positive-smoking associations were stronger for smokers relative to nonsmokers. Within the subgroup of nondaily smokers, more frequent co-use of alcohol and cigarettes was associated with stronger implicit positive-smoking associations when controlling for total drinking and smoking frequency. The findings suggest that implicit alcohol and smoking associations may be linked with smoking patterns (daily vs. nondaily) and co-use of alcohol and cigarettes among young adult drinkers who are not heavy smokers, highlighting the need for more research on the role of implicit associations in the co-use of cigarettes and alcohol.