Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.     

EFFECTS OF REINFORCER QUALITY ON BEHAVIORAL MOMENTUM: COORDINATED APPLIED AND BASIC RESEARCH

The high-probability (high-p) instructional sequence has been an effective treatment for noncompliance. However, treatment failures have also been reported. We hypothesized that the efficacy of the high-p treatment may be improved by using higher quality reinforcers for compliance to high-p instructions. The resistance of compliance to change was tested by varying reinforcer quality in two applied studies and a basic laboratory experiment. Experiment 1 tested the hypothesis that an increase in reinforcer quality for high-p compliance will increase the effectiveness of the high-p treatment when it fails to increase compliance. Experiment 2 assessed the effects of reinforcer quality on resistance of compliance to change by presenting successive low-p requests following the high-p treatment. A basic laboratory study (Experiment 3) was conducted to further isolate the relation between reinforcer quality and behavioral momentum. Two different liquid reinforcers (sucrose and citric acid solutions) were presented in a two-component multiple variable-interval variable-interval schedule followed by a single extinction test session. Results of all three experiments showed a generally consistent relationship between reinforcer quality and behavioral momentum.     

The role of individual differences,response profiles,and treatment consonance in anxiety disorders

The importance of individual differences, response profiles, and treatment consonance in anxiety-disorders clinical research is reviewed. Anxiety-disorders assessment, synchrony, and concordance phenomena are examined within the framework of the tripartite model. Issues regarding response stereotypy, response specificity, and etiological vs. current response typologies are discussed. Interactions of varying response profiles with different treatment modalities are addressed, in terms of both previous and prospective studies. A preliminary classification schema is offered, for illustrative purposes, with empirical support for the differential outcome of anxiety patients receiving consonant vs. nonconsonant response profile × treatment type pairings. Hypotheses are presented regarding predicted effects of consonant vs. nonconsonant subject-treatment interactions. Recommendations for programmatic research are offered to accelerate scientific inquiry into the role of individual differences and response profiles in anxiety-disorders assessment, treatment, and research.Preparation of this paper was supported in part by National Institute of Mental Health Grant MH 36299.     

A SUPERVISION PROGRAM FOR INCREASING FUNCTIONAL ACTIVITIES FOR SEVERELY HANDICAPPED STUDENTS IN A RESIDENTIAL SETTING

This study was designed to increase the amount of time severely handicapped students living in a residential facility engaged in age-appropriate and functional activities. After a brief in-service training, a program involving instructions to supervisors and staff feedback was implemented in a multiple-baseline design across settings. Results showed that after the supervision program was implemented, the students' participation in activities increased. Further, these increases maintained when feedback was reduced from an average of 3 days a week during treatment, to once a month for a 5-month period.     

CONTINGENT REINFORCEMENT FOR BENZODIAZEPINE-FREE URINES: EVALUATION OF A DRUG ABUSE TREATMENT INTERVENTION

This study evaluated contingent reinforcement for benzodiazepine-free urines as a therapeutic intervention for promoting reduced use of supplemental benzodiazepine drugs among methadone maintenance outpatients. Ten methadone maintenance patients were selected for participation on the basis of positive urinalysis results. During a 12-week intervention period these patients were offered clinic privileges, including monetary payments or methadone take-home doses, contingent on benzodiazepine negative urinalysis test results. Eight of ten participants responded to the intervention with at least 2.5 weeks of consecutive clean urines. An increase in benzodiazepine-negative tests during the contingent reinforcement period was significant for the group as a whole. The results suggest that more widespread application of contingent reinforcement procedures may be warranted in drug abuse treatment clinics.     

ON TOKEN REINFORCEMENT AND STUTTERING THERAPY: ANOTHER VIEW ON FINDINGS REPORTED BY HOWIE AND WOODS (1982)

Howie and Woods (1982) have provided data that, they claim, indicate that a token reinforcement system is redundant in instating and shaping fluent speech within a stuttering treatment program developed by Ingham and Andrews (1973a, b). However, there were substantial procedural differences between the treatment programs referred to in both studies, as well as methodological weaknesses in Howie and Woods' study. These factors provide ample sources of explanation for Howie and Woods' failure to demonstrate benefits from their token reinforcement system.     

Treatment of Young Children's Bedtime Refusal and Nighttime Wakings: A Comparison of “Standard” and Graduated Ignoring Procedures

Young children with sleep problems received either standard or graduated ignoring treatment. Both brief treatments were superior to a wait-list control condition and resulted in comparable improvements in bedtime and nighttime sleep problems. At bedtime, the treatments did not differ with respect to maternal compliance and stress. For nighttime wakings, mothers in the graduated ignoring group reported higher rates of compliance and less treatment-related stress. Maternal characteristics predicted treatment outcome in the standard ignoring condition. Following treatment, only positive side effects were observed. When compared to the wait-list group, mothers in the standard ignoring group reported less verbose discipline and decreased stress in parenting, while mothers in the graduated ignoring group reported improved parent–child relationships. Treatment gains were maintained over a 2-month follow-up period.     

Codependency: An Empirical Study from a Systemic Perspective

To empirically investigate the construct validity of codependency, differences between young adults on a measure of codependency on theoretically relevant variables were examined. Compared with individuals who scored low on codependency, those who obtained high scores reported significantly more family of origin difficulties and parental mental health problems, problematic intimate relationships including relationships with chemically dependent partners, and personal psychological problems including compulsivity. Contrary to prevailing theoretical predictions the high codependency group did not contain more individuals whose parents had alcohol or drug abuse problems, or a higher level of childhood physical or sexual abuse. These results suggest that co-dependency is one aspect of wider multigenerational family systems problems which are not unique to families where drug and alcohol abuse or physical and sexual abuse are major concerns.     

Child victims: Searching for opportunities to break the cycle of violence

In 1986 I began research to address the relationship between early child abuse and neglect and later deliquent and violent criminal behavior using a prospective cohort design. The relationship is not inevitable, suggesting an opportunity for long-range violence prevention through appropriate early intervention. Here, I briefly describe how childhood victimization and violent criminal behavior are related and illustrate a number of promising strategies and opportunities to intervene. Finally, I offer five principles to guide interventions: (1) the earlier the intervention, the better; (2) don't neglect neglected children; (3) one size does not fit all; (4) surveillance—a double-edged sword; and (5) accessibility to resources. Rather than focusing on responses to child abuse or neglect in court proceedings that “treat” offenders, primary prevention efforts should target childhood victims to reduce their risk of becoming offenders in the future.