„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.     

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.