Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid

System-wide research on the use of out-of-home care among children and youth is needed to inform the development of policies and services. We used Medicaid claims from North Carolina to examine patterns of out-of-home care, identify demographic and diagnostic differences between those who received care in residential treatment, psychiatric hospitals, or general hospitals, and determine whether demographic or diagnostic characteristics were associated with having more than one out-of-home stay during the year. Among those who received out-of-home care during a 1 year period, 36% received care in residential treatment only, 32.4% in general hospitals only, and 17.6% in psychiatric hospitals only, while 14.0% used more than one sector of out-of-home care. Boys, teenagers, and youth in foster care or diagnosed with emotional disturbance or hyperkinetic syndrome had higher odds of receiving care in residential treatment only whereas girls, youth age 19–21, and those with depressive and stress and adjustment disorders had higher odds of receiving care from hospitals only. Teenagers and youth in foster care had higher odds of having more than one stay. Among those with more than one stay, there were 300 patterns of care and nearly half received care from more than one service sector. The implications for services and policy are discussed. Further research is needed to understand patterns of out-of-home care and the factors that influence placement decisions.     

Neural and behavioral effects of interference resolution in depression and rumination

Individuals diagnosed with major depressive disorder (MDD) often ruminate about their depression and their life situations, impairing their concentration and performance on daily tasks. We examined whether rumination might be due to a deficit in the ability to expel negative information from short-term memory (STM), and fMRI was used to examine the neural structures involved in this ability. MDD and healthy control (HC) participants were tested using a directed-forgetting procedure in a short-term item recognition task. As predicted, MDD participants had more difficulty than did HCs in expelling negative, but not positive, words from STM. Overall, the neural networks involved in directed forgetting were similar for both groups, but the MDDs exhibited more spatial variability in activation in the left inferior frontal gyrus (a region critical for inhibiting irrelevant information), which may contribute to their relative inability to inhibit negative information.     

Aging and the use of context in ambiguity resolution: complex changes from simple slowing

Older and younger adults' abilities to use context information rapidly during ambiguity resolution were investigated. In Experiments 1 and 2, younger and older adults heard ambiguous words (e.g., fires) in sentences where the preceding context supported either the less frequent or more frequent meaning of the word. Both age groups showed good context use in offline tasks, but only young adults demonstrated rapid use of context in cross-modal naming. A 3rd experiment demonstrated that younger and older adults had similar knowledge about the contexts used in Experiments 1 and 2. The experiment results were simulated in 2 computational models in which different patterns of context use were shown to emerge from varying a single speed parameter. These results suggest that age-related changes in processing efficiency can modulate context use during language comprehension.     

The historical context of G. Stanley Hall's Adolescence (1904)

G. Stanley Hall's magnum opus, Adolescence, published in 1904 in two hefty volumes I herein submit to historical analysis. I am concerned with how it did "fit" into the notions and practices of the larger culture as well as into the discourses of science and of child nurture of that time. There is plenty of evidence of Hall's ethnic, racial, and gender attitudes as expressed in the book being typical of the white, Anglo-Saxon Protestant middle class stratum to which he belonged. His discussions of the extant discourses of science and of child nurture show a man quite conversant with these discourses, and not merely in American and British, but also in French and German publications as well. Probably any book, idea, or historical circumstance or phenomenon is chiefly a historical artifact, and we should not bend it much to "prove" that it is in any important sense a part of a different age. It is one thing to say that a certain idea has a contemporary resonance; to claim there is a straight line from it to today is problematic and meaningless.     

Fear information and social phobic beliefs in children: a prospective paradigm and preliminary results

This paper presents a first attempt to develop a prospective paradigm to test Rachman's (Behav. Res. Ther. 15 (1977) 375) theory of fear acquisition for social fears. Following the prospective paradigm for animal fears developed by Field et al. (Behav. Res. Ther. 39 (2001) 1259) an attempt is made to adapt this paradigm to look at the effect of fear information in the development of social fears. A large group of normal children (N=135) who were at an age (10-13 years) at which social concerns are most pertinent were tested using this paradigm. They were given positive, negative or neutral information about three social situations: public speaking, eating in public, and meeting a new group of children. Children's fear beliefs were measured before and after the information was given and the information was given by a teacher, a same age peer or no information was given (a control). The results indicate that although information can change social fear beliefs it is dependent upon the type of social activity and who provides the information. The implications of these initial results for our understanding of both the role of fear information in the development of social fear beliefs, and the limitations of this current paradigm are discussed.     

Family-expressed emotion,childhood-onset depression,and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to express their appreciation to Sybil Zaden and Ana Magana-Amato for their assistance coding the FMSS-EE data, to Gwen Gordon for her assistance with data analysis, and to the families participating in the project.