Psychotherapy and Pharmacotherapy Treatment Outcome Research in Pediatric Populations

Reviewed treatment interventions for pediatric populations involving the combination of pharmacotherapy or psychotherapy or either treatment employed alone. The literature revealed a dearth of psychotherapy and pharmacotherapy outcome studies, with the exception of investigations of children diagnosed with attention-deficit hyperactivity disorder (ADHD). Issues pertaining to design, including sample selection, treatment integrity and comparability, and placebo controls also are reviewed. A potpourri of other issues are noted including parental attitudes toward the use of medication versus psychotherapy, treatment adherence, and patient/provider relationship. For children diagnosed with ADHD, the use of stimulant medication appears to be superior to psychotherapy employed alone in managing the behavior of these children as well as their classroom functioning. Recommendations are made for multimodal trials that examine the combined and individual use of pharmacotherapies and psychotherapies for various developmental and psychiatric disorders that occur in childhood and adolescence. Future studies also need to address the durable effects of these treatment options.     

Effective Treatment for Mental Disorders in Children and Adolescents

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.     

Impact of substance abuse and child maltreatment training on service utilization in a rural setting

Substance abuse and child maltreatment have been recognized as co-morbid problems encountered in families presenting in the child protective services (CPS) system. Nonetheless, utilization rates of substance abuse treatment services have generally lagged well behind what the research would suggest are prevalence rates for substance abuse disorders in this population, suggesting problems in recognition and referral practices among CPS workers. In response to this, 25 training programs were funded by the National Center on Child Abuse and Neglect. This study reports data from one program. Trainees indicated a high level of satisfaction and demonstrated significant knowledge gains. More importantly, utilization of substance abuse services increased significantly across time in a multi-county region receiving training relative to a comparison region receiving none. The gain was limited, suggesting that while increased knowledge may translate into increased service utilization, additional barriers to accessing needed services must also be addressed.     

ACQUISITION AND GENERALIZATION OF COMPLIANCE WITH COMPLEX FIVE-COMPONENT INSTRUCTIONS1

A 7-yr-old bilingual boy of normal intelligence, judged by his school to be deficient in carrying out complex requests, was trained to comply with five-component instructions, e.g., “Give me/the chip/behind/the block/on blue”. Three interchangeable words or phrases were used for each component. Training proceeded in stages. First, the child was trained to identify all individual objects and actions; then to carry out requests involving only the first component, then the first two, then three, etc. On every trial, the visual setting permitted every possible response in the set. A test for generalization to nonreinforced instructions was given at each stage by giving no feedback for all instructions that included one preselected phrase. The phrase selected at each stage was one of the three that was introduced at that stage. As a further test for generalization, nonreinforced instructions were also given that included one additional component: the next to be trained (Probes Ahead). As a test for generalization across settings and instructions, several five-component instructions were presented each session in an unused classroom. These instructions used phrases, most of which were different from those being trained, and which referred to familiar classroom objects. Results showed: acquisition occurred for each stage of training, including the full five-component instruction; almost complete generalization of responding occurred to the subset of nonreinforced instructions; little or no generalization occurred to the Probes Ahead, where an additional untrained component was included; and little or no generalization was seen to the five-component classroom instructions, until training began on the five-component instructions in the training sessions. Performance was also examined for each component. Results showed that when a new component was introduced, correct performance to previously trained components declined, and was little if any superior to performance on the new component. In summary, transfer was found to untrained sentences of the same form as those being trained, even in another setting, where most of the components were different; but poor transfer was found to more complex sentences, and performance declined for previously trained components during training of a more complex sentence. Some features of the training procedure that may have affected the degree and form of transfer were discussed: the necessity for prior training in an appropriate response to the component phrases, the importance of intermixing of reinforced and nonreinforced trials, and the effects of the abruptness with which more complex sentence forms were introduced.     

TREATMENT OF CHILD ABUSE: A REVIEW OF THE BEHAVIORAL INTERVENTIONS

The problem of child abuse has become prominent in the past decade; this has led to increased research on its treatment. This paper describes the behavioral treatment approaches that have been used to alleviate abusive parenting practices, and it also discusses current issues and future directions for research in this area.     

A comparison of methods for assessing child compliance during behavioral parent training

The purpose of the present study was to compare four methods of computing child compliance to parental instructions. Four noncompliant boys, ages 2.5 to 7 years, participated with their mothers in behavioral parent training. In order to evaluate the training, observers recorded the boys' compliance responses in continuous 10-sec intervals. The boys' rates of compliant responding were then computed by considering behavior (A) only in the first interval following the instruction, (B) in the first three intervals following the instruction, (C) in all intervals while the instruction was ongoing, and (D) only in the final interval of the instructional trial. The findings indicated that the first three methods were correlated strongly with each other, although there were occasional differences in the levels of compliance indicated by these three methods. The implications of the findings and the merits of each of the four methods are discussed.     

TEACHING A PARENT TO TRAIN A SPOUSE IN CHILD MANAGEMENT TECHNIQUES

This study analyzed several aspects of the training of a mother and father in child management techniques for use with their 6-year-old severely developmentally delayed son. The mother received clinic training in procedures for increasing her son's independent dressing skills; subsequently, she was asked to teach the same procedures to her husband with no assistance from the trainer. For both parents, procedures were introduced sequentially across two components of parent behavior in a multiple baseline design. Examinations were made of (a) the effectiveness of initial child management training on the mother's behaviors, (b) her ability to teach the same techniques to her husband independently, (c) the generalization of both parents' skills from the training setting (a dressing task) to two untrained activities (eating and toy use), and (d) the impact of training on the child's behavior. Results showed that the mother learned to implement the trained procedures and successfully communicated them to her husband, as evidenced by substantial positive changes in both parents' behaviors after being introduced to the child management skills. Both parents showed some generalization to the untrained activities, and their written comments following training indicated they understood the procedures. Clear-cut improvements were observed in the child's attending and independent performance of dressing and toy use skills concurrent with parent training. A 2-year follow-up report indicated that both parents retained their knowledge of skills taught, continued to use the procedures, and rated the training as very helpful in teaching the child self-help skills.     

学习困难儿童的神经心理研究

本研究用中国修订的HR成套神经心理测验(HRB(m)-RC)、韦氏儿童智力量表(WISC-CR)、韦氏记忆量表(WMS-RC)和分类测验测查9—14岁学习困难儿童和正常儿童各50名。研究了学习困难儿童的神经心理特点和神经心理功能与学习成绩的关系,从神经心理学角度来讨论学习困难的教育干预。     

The psychometric properties of the penile tumescence assessment of child molesters

The presence of sexual arousal to children or a sexual preference for children are commonly hypothesized as being related to child molesting. Sexual arousal and sexual preference do not appear to be accurately assessed by traditional assessment methods such as the clinical interview and traditional personality testing or by projective testing (Earls, 1992). Penile tumescence measurement is an increasingly utilized method for assessing sexual arousal and preference in child molesters. The published literature concerning the psychometric properties of this technology as used with child molesters is critically reviewed. Basic questions concerning the sexual preference hypothesis, the criterion problem, the lack of procedural standardization, the kind of test penile tumescence measures exemplifies, and potentially problematic inferences involved in penile tumescence assessment are examined. There is evidence of test-retest and internal consistency reliabilities for certain penile tumescence measurement procedures. While there are a significant number of studies providing evidence that these techniques can accurately distinguish child abusers from nonoffenders, many are plagued by methodological problems. Suggestions for future research are given.The authors would like to thank Henry Adams, Christopher Earls, Steven R. Gold, D. Richard Laws, Barry M. Maletzky, and several anonymous reviewers for their comments on earlier versions of this paper.     

Child psychopathology and deviant family hierarchies

The association between child psychopathology and reversals in family hierarchies (where the child is seen as equal or higher in the hierarchy than the parental figures) were examined with the Madanes Family Hierarchy Test on a sample of 177 clinic-referred boys. Madanes' original findings of the association of substance use and deviant family hierarchy were replicated in this younger sample, (age 7 to 12). Boys diagnosed with Conduct Disorder reported significantly more deviant hierarchies while boys diagnosed with Overanxious Disorder reported significantly fewer deviant hierarchies. Follow-up results revealed some instability and lack of informant agreement, but the hierarchy measure was not confounded by age, race, SES, IQ, or parents' marital status.