The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on “family‐based treatment” rather than on the theoretic orientation “systemic therapy.” We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems‐oriented therapy in various forms (family, individual, group, multi‐family group therapy) with child or adolescent index patients (0–17 years) suffering from mental disorders were identified by data base searches and cross‐references. Inclusion criteria were as follows: index patient diagnosed with a DSM‐ or ICD‐listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow‐up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow‐up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.     

'Gonnae no' dae that!'1 the internal and external worlds of the delinquent adolescent

In understanding delinquency in adolescence the key theoretical papers on the role of oedipal resolution and superego development remain essential and are summarized. To this we need to add our knowledge of trauma and of developmental deficit if we are to offer appropriate strategies for young delinquents and to be able to select those for whom therapy, intervention with the network or containment are appropriate. The defence of activity, commonplace in adolescence, becomes too easily enacted in the network around the delinquent and in the public domain, and thoughts are given on this process and on the roles open to the psychotherapist.

Afin de mieux cerner la délinquance chez l'adolescent, l'auteur passe en revue certains textes théoriques fondamentaux et toujours d'actualité sur l'importance de la dissolution du complexe d'?dipe et de la mise en place du Surmoi. À ces thèmes il convient d'ajouter ce que nous connaissons de l'impact des traumatismes et des défaillances développementales si nous voulons offrir au jeune délinquant des stratégies adéquates et identifier ceux pour qui une modalité particulière d'intervention - thérapie, prise en charge en réseau, structure contenante - semble la mieux indiquée. La défense par mise en acte, fréquente À l'adolescence, trouve trop facilement un écho dans le réseau d'intervenants autour de l'adolescent et dans le champ social ; l'auteur développe ses réflexions À ce sujet et explore les rôles que le thérapeute peut être amené À jouer.     

The Relationship Between Cumulative Risk and Promotive Factors and Violent Behavior Among Urban Adolescents

Resiliency theory posits that some youth exposed to risk factors do not develop negative behaviors due to the influence of promotive factors. This study examines the effects of cumulative risk and promotive factors on adolescent violent behavior and tests two models of resilience—the compensatory model and the protective model—in a sample of adolescent patients (14–18 years old; n = 726) presenting to an urban emergency department who report violent behavior. Cumulative measures of risk and promotive factors consist of individual characteristics and peer, family, and community influences. Hierarchical multiple regression was used to test the two models of resilience (using cumulative measures of risk and promotive factors) for violent behavior within a sample of youth reporting violent behavior. Higher cumulative risk was associated with higher levels of violent behavior. Higher levels of promotive factors were associated with lower levels of violent behavior and moderated the association between risk and violent behaviors. Our results support the risk-protective model of resiliency and suggest that promotive factors can help reduce the burden of cumulative risk for youth violence.     

Moral judgement in adolescents: Age differences in applying and justifying three principles of harm

This study investigated the application and justification of three principles of harm in a cross-sectional sample of adolescents in order to test recent theories concerning the source of intuitive moral judgements. Participants were 46 early (M _age = 14.8 years) and 40 late adolescents (M _age = 17.8 years). Participants rated the permissibility of various ethical dilemmas, and provided justifications for their judgements. Results indicated participants aligned their judgements with the three principles of harm, but had difficulty explaining their reasoning. Furthermore, although age groups were consistent in the application of the principles of harm, age differences emerged in their justifications. These differences were partly explained by differences in language ability. Additionally, participants who used emotional language in their justifications demonstrated a characteristically deontological pattern of moral judgement on certain dilemmas. We conclude adolescents in this age range apply the principles of harm but that the ability to explain their judgements is still developing.     

Cross-ethnic friendships,psychological well-being,and academic outcomes: Study of South Asian and White children in the UK

We examined whether two interpersonal processes, self-disclosure and affirmation of ideal self, mediated the relationship between cross-ethnic friendships and psychological well-being and academic outcomes. We conducted a cross-sectional survey with 484 secondary school children (243 White European, 241 South Asian British; M_age = 11.10, 220 boys, 264 girls) recruited from 35 multiethnic classrooms. Results of multilevel structural equation modeling revealed mediational effects of self-disclosure between cross-ethnic friendships and psychological well-being for only South Asian children. Affirmation also mediated the association between cross-ethnic friendships and both psychological well-being and academic outcomes for South Asian children. For White European children, affirmation mediated the association between cross-ethnic friendships and psychological well-being. Further analyses demonstrated that self-disclosure resulting from cross-ethnic friendship quality facilitated affirmation, which in turn promoted both sets of outcomes. Findings demonstrate that cross-ethnic friendships in multiethnic settings contribute to well-being through the generation of positive interpersonal processes.     

Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy

Previous research has provided inconclusive evidence regarding the neuropsychological difficulties of children born to mothers partaking in opioid or poly-drug use during pregnancy. Little is known about how these children fare as they get older. The present longitudinal study includes follow-up data on 45 children born to mothers who used heroin and poly-drugs and a group of 48 children without prenatal drug exposure. Most of the drug-exposed youths were placed in permanent foster or adoptive homes before one year of age. The youths (ages 17 to 21) were administered 10 neuropsychological tests. The drug-exposed youths had cognitive and fine motor functions within the normal range compared to population norms but performed significantly worse than the non-exposed group. There were indications of generally lower cognitive functions rather than specific problems with executive functioning. Lower mean birthweight in the risk group (619 grams mean difference, p < .001) only partially mediated the group differences in cognitive functioning. There was a tendency for youths who had few and early changes in their caregivers or who were born to mothers who had used the least number of different drugs during pregnancy to have the best cognitive scores. The study indicates that youths born to mothers who used multiple drugs during pregnancy are vulnerable relative to their peers within a wide range of cognitive functions. The vulnerability seems to be related not only to the mother’s drug use during pregnancy but also to factors such as birthweight and unstable parental care during infancy.     

Longitudinal Linkages Between Posttraumatic Stress Disorder Symptoms and Violent Behaviors Among Chinese Adolescents Following the Wenchuan Earthquake

This study was conducted to examine the longitudinal relations between posttraumatic stress disorder (PTSD) symptoms and violent behaviors. In this study, 415 adolescent survivors of the Wenchuan earthquake in China (May 12, 2008) were assessed by using self-report questionnaires 1 year (T1), 1.5 years (T2), and 2 years (T3) after the earthquake. The findings suggested that from 1 to 1.5 years after the earthquake, only intrusive symptoms of PTSD were a risk factor for violent behaviors, whereas violent behaviors were a risk factor for all 3 PTSD symptom clusters. Furthermore, 1.5 to 2 years after the earthquake, avoidance symptoms of PTSD were a risk factor for violent behaviors and hyperarousal symptoms of PTSD had no significant relation with violent behaviors.     

Tolerance and Perception of Abuse in Youth Dating Relationships

A cross-sectional study of pre-university and university students of both genders was carried out in Spain (N = 4,919) to determine the levels of tolerance of partner violence per gender and the perception of abuse. Of the students, 26.3% were in a situation of unperceived abuse, especially the males (29.6%), but the level of tolerance of abusive behavior was significantly lower in females. The group of youths who did not perceive themselves as abused had higher levels of tolerance. In contrast, non-abused students presented low tolerance of violent behavior. Tolerance of dating violence is more strongly determined by gender than by the perception of abuse in young people.     

Family structure and family processes in Mexican-American families

Despite increases in single-parent families among Mexican Americans, few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican-American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single-parent families reported greater school misconduct, conduct disorder/oppositional deviant disorder, and major depressive disorder symptoms, and greater parent-child conflict than their counterparts in 2-parent families. Single-parent mothers reported greater economic hardship, depression, and family stress. Family stress and parent-child conflict emerged as significant mediators of the association between family structure and early adolescent outcomes, suggesting important processes linking Mexican-American single-parent families and adolescent adjustment.