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.     

The Future of Psychology in Pain Management

Pain treatment facilities have proliferated in recent years and psychology has enjoyed considerable success in the clinical and research arenas of pain management. However, changes in the health care environment present significant challenges to the future of psychology in pain management. This article discusses concerns in three important areas of pain treatment that psychologists must address if they are to maintain a strong presence in this field: (1) evaluating and treating patients in the pain treatment setting, (2) evaluating and enhancing the efficacy of pain treatment, and (3) applying pain treatment services to other patient populations. With appropriate attention to these issues, psychology can continue to thrive in pain treatment settings.     

Letter to a genetic counselor

The author describes her personal experience terminating a pregnancy after receiving an abnormal amniocentesis result: While still waiting for the results, she and her husband attempted to deny the importance of the pregnancy, an approach which they subsequently regretted. When they received the abnormal result, they found themselves able to make necessary decisions quickly, despite being in shock. It then took some time before they realized what a major loss they had actually suffered. The painful aftermath included accepting emotional responsibility for their decision to abort, as well as explaining that difficult decision to their older children. Thoughts of a possible subsequent pregnancy could not be faced at once. Over time, the author found the support of friends and colleagues, and even of a support group, to be invaluable. All in all, the entire experience was more painful than she would have predicted, and she hopes that this account will prove helpful both to genetic counselors and to other patients who receive abnormal results from prenatal diagnosis. A list of suggested readings is appended.Rose Green is a pseudonym.     

‘Attentional Bias’ in correlation judgments? Smedslund (1963) revisited

Smedslund (1963) reports one of the first studies that investigated human judgments of correlation. Smedslund's conclusion, that people reason about correlation mostly from a consideration of the number of times two variables co-occur, has become textbook wisdom (e.g. Baron's "attentional bias", 1994). Yet the data reported in Smedslund's paper fall short of endorsing such a conclusion. After reviewing the original paper, we present the method with which we replicated Smedslund's main experiment. In Experiment 1 subjects were presented with symptom-disease correlation data through a simulated medical diagnosis task. Subjects clearly discriminated between data sets which shared an equal number of symptom-disease co-occurrences but which otherwise showed different levels of correlation. Subjects' diagnoses showed a propensity to predict the disease in the presence of the symptom, and symptom-disease co-occurrences were overestimated in two of the five data sets presented to the subjects. Experiment 2 used a novel abstract scenario with a symmetric predictor variable. Judgments again indicated good discrimination, and biases in prediction responses and case recall were eliminated. In both experiments, judgments of zero correlation were a function of the outcome base rate. We evaluate and contrast the extent to which Cheng's (1997) model of causal induction and two associative models, Rescorla and Wagner (1972) and Pearce (1987) can anticipate the observed pattern in the mean judgments.     

主动控制感在大脑表征中的时空标记

主动控制感是主动动作过程中产生的控制自身动作, 进而控制外部环境的主观体验。构成动作主动控制感的核心要素是主观意图与结果反馈。本研究试图通过操控这两个核心要素的不同属性, 借助脑磁图等技术, 探寻主动控制感在大脑额-顶为主的脑网络中前-后馈的作用方式及时空特异性标记, 并建构新的认知神经理论模型。这将有利于理解人类动作的产生及后效、为相关精神类疾病的临床诊断提供更加客观的参照标准。     

童年期抑郁情绪发展的异质性与可预测性:2年追踪研究

以儿童抑郁量表为研究工具,对小学3到4年级771名儿童进行了2年的追踪研究。采用潜类别增长模型和终端结局潜发展模型,分别考察了童年期儿童抑郁情绪发展的亚群组类型,以及儿童抑郁情绪的发展特征对观察期结束时抑郁情绪的预测作用。结果表明：（1）童年期儿童的抑郁情绪发展呈现出三种不同的亚类型,即抑郁高风险组、抑郁低风险组和抑郁自愈组,各类型组人数比例分别为9.6%、53.4%和36.8%;（2）童年期儿童抑郁情绪的初始水平及其发展变化率均可以显著预测观察期结束时的抑郁情绪状况。童年期儿童抑郁情绪的早期监测工作有着重要的实践意义。     

Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.     

Relating latent class membership to external variables: An overview

In this article we provide an overview of existing approaches for relating latent class membership to external variables of interest. We extend on the work of Nylund-Gibson et al. (Structural Equation Modeling: A Multidisciplinary Journal, 2019, 26, 967), who summarize models with distal outcomes by providing an overview of most recommended modeling options for models with covariates and larger models with multiple latent variables as well. We exemplify the modeling approaches using data from the General Social Survey for a model with a distal outcome where underlying model assumptions are violated, and a model with multiple latent variables. We discuss software availability and provide example syntax for the real data examples in Latent GOLD.     

Five‐year outcomes of ADHD diagnosed in adulthood

There is a dearth of long‐term follow‐up studies of adults diagnosed with ADHD. Here, the aim was to evaluate long‐term outcomes in a group of ADHD patients diagnosed in adulthood and receiving routine psychiatric health care. Adults diagnosed with any type of ADHD (n = 52) and healthy controls (n = 73) were assessed at baseline and at a 5‐year follow‐up, using Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Brown ADD Scale (BADDS) and Adult ADHD Self‐Report Scale (ASRS). A multivariate regression method was used to identify factors predicting 5‐year outcomes, including baseline ratings, medication intensity, comorbidity, intelligence quotient (IQ), age, and sex. After 5 years, ADHD patients reported fewer and/or less severe symptoms compared to baseline, but remained at clinically significant symptom levels and with functional deficits. Baseline self‐reports of ADHD symptoms predicted their own 5‐year outcome and low baseline functioning level predicted improved global functioning at follow‐up. Factors previously reported to predict short‐term outcomes (i.e., medication, comorbidity, IQ, age, and sex) did not anticipate long‐term outcomes in present study.     

Identification of biological and environmental risk factors for language delay: The Let's Talk STEPS study

The aim of this population-based study was to identify demographic factors for language delays at an early age. The risk analysis covered 11 biological and 8 environmental factors. The mothers’ concerns regarding language development were also examined. A total of 226 children from a Finnish cohort study were invited to participate in language assessments at 36 months. The test results for word finding and language comprehension were compared with parental questionnaires about children's vocabulary at 13 and 24 months.Regression analysis revealed that the father's social class (t = −2.79, p = 0.006) and working full time (t = −2.86, p = 0.005) significantly predicted children's language delay. In addition, language comprehension was significantly predicted by the mother's social class (t = −2.06, p = 0.041) and by gender, with an advantage to girls (t = −2.71, p = 0.008). Vocabulary at 24 months was a powerful predictor for lexical development (t = 4.58, p < 0.0001) and language comprehension (t = 4.85, p < 0.0001) at 36 months. Mothers’ concerns were correlated with children's limited lexicons as early as 24 months (r = 0.31, p < 0.0001) and poor language comprehension (r = −0.35, p < 0.0001) at 36 months. Mothers were especially concerned if the parents needed special education during school years.At the population-level, gender was the most powerful biological factor in predicting language delays. Similarly, both parents’ social status had predictive value for the child's language development. In addition, it was found that the mother's concern about her child's slow language acquisition should be taken into account when making decisions regarding special support.