Behavioral family therapy symposium

Abstract

The Albert Einstein College of Medicine/Montefiore Medical Center (AECOM/MMC) Department of Psychiatry and the Gralnick Foundation/ High Point Hospital jointly sponsored the Second Annual Einstein Symposium on November 7, 1985 commemorating the centennial year of Yeshiva University. The symposium, focusing on Behavioral Family Therapy, opened with the presentation of the Einstein Award for Research in Psychiatry to B. F. Skinner by Herman van Praag, Chairman of the Department of Psychiatry. After Skinner's discussion of the role of emotions in behavior analysis, several nationally renowned clinical researchers in the field of behavioral family therapy presented findings of their recent work.     

A longitudinal intergenerational analysis of executive functions during early childhood

Despite the importance of executive function (EF) in both clinical and educational contexts, the aetiology of individual differences in early childhood EF remains poorly understood. This study provides the first longitudinal intergenerational analysis of mother–child EF associations during early childhood. A group of children and their mothers (n = 62) completed age‐appropriate EF tasks. Mother and child EFs were modestly correlated by 24 months of age, and this association was stable through 48 months. Importantly, maternal–child EF associations were still robust after controlling for verbal ability (potential indicator of verbal/crystallized intelligence) and maternal education (correlate of socio‐economic status and verbal intelligence). Potential implications of these findings as well as underlying mechanisms of the maternal–child EF association (gene–environment interplay) are discussed.     

Can Children with Autism Recover? If So, How?

Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.     

Pathways from infant exposure to marital conflict to parent–toddler role reversal

We know that exposure to marital conflict places infants at risk, but we know less about processes. One process may be role reversal, when a distressed parent looks to the child to meet unmet needs for comfort, intimacy, or companionship. A parent in marital conflict may be particularly prone to role reversal, which in turn adversely affects child development. The current study examined pathways from infants' exposure to marital conflict at 12 months to role reversal at 24 months. We sampled low–middle socioeconomic status (SES) families with their first child (N = 128). Independent observers assessed marital conflict (in a problem‐solving task) and role reversal (in a story‐telling task). We found that each parent's conflict behavior predicted the other parent's role reversal. In a direct pathway, mother's conflict behavior towards father led directly to father's role reversal with the child. In an indirect pathway, father's conflict behavior towards mother led to his withdrawal from her, which in turn led to mother's role reversal with the child. Clinical implications are discussed within a developmental psychopathology framework in terms of preventive interventions to offset the deleterious effect of marital conflict and role reversal on child development.     

ADHD and aggression as correlates of suicidal behavior in assaultive prepubertal psychiatric inpatients

Forty-three psychiatrically hospitalized prepubertal children were assessed regarding their assaultive and suicidal behaviors. These children were subsequently classified into two groups, assaultive/suicidal (AS) and assaultive-only (AO). AS children had higher aggression and suicidal-scale scores, but not higher depression scores, and were more likely to be diagnosed with ADHD. ADHD, child's aggression, and maternal depression and state anger accounted for 33% of the variance in suicidal-scale scores. Aggression mediated the relation between ADHD and suicidal behavior. Differences in symptom pattern between these two subtypes of assaultive inpatient children are interpreted as a basis for distinctive screening procedures.     

Longitudinal study of a school based HIV/AIDS early prevention program for Mexican adolescents

A quasi-experimental study is reported with four measurement occasions to evaluate longer-term effects of a life-skills and HIV/AIDS school-based prevention program. Trained teachers administered the program promoting precursors of safer sex behavior to 2064 Mexican high-school students at an age before most were sexually active. The variables included in the study (knowledge about HIV/AIDS prevention, attitudes towards use of condoms, subjective norms, intentions to use condoms and life skills as decision-making skills, partner communication and individual responsibility) have been reported as precursors of protective sexual behavior. The results demonstrate the stability of training effects and a positive impact on these precursors over 1 year of follow-up.     

Environmental stimulation, parental nurturance and cognitive development in humans

The effects of environmental stimulation and parental nurturance on brain development have been studied extensively in animals. Much less is known about the relations between childhood experience and cognitive development in humans. Using a longitudinally collected data set with ecologically valid in-home measures of childhood experience and later in-laboratory behavioral measures of cognitive ability, we were able to test hypotheses concerning the effects of environmental stimulation and parental nurturance. A double dissociation was found: On the one hand, there was a selective relation between parental nurturance and memory development, consistent with the animal literature on maternal buffering of stress hormone effects on hippocampal development. On the other hand, there was a selective relation between environmental stimulation and language development. The relevance of these findings to socioeconomic gradients in cognitive ability is discussed.     

Narrative Therapy Using a Reflecting Team: An Ethnographic Study of Therapists' Experiences

Narrative therapy in the last 15 years has been utilized by many clinicians and yet there is a lack of research on therapists' experience of this approach. This ethnographic research explores the views and perceptions of eight narrative therapists who belonged to a narrative team in an outpatient clinic. These therapists were observed and interviewed. Five themes emerge from the data. The themes include a sense of success in reducing the clients' problems as well as some limitations of narrative therapy. Two recommendations for research and practice involve the use of narrative therapy without a team and the use of narrative therapy in addressing issues of family violence.