Change in interpersonal problems after cognitive agoraphobia and schema-focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders

The aim was to study whether patients with panic disorder with agoraphobia and co-occurring Cluster C traits would respond differently regarding change in interpersonal problems as part of their personality functioning when receiving two different treatment modalities. Two cohorts of patients were followed through three months' in-patient treatment programs and assessed at follow-up one year after end of treatment. The one cohort comprised 18 patients treated with "treatment as usual" according to psychodynamic principles, the second comprised 24 patients treated in a cognitive agoraphobia and schema-focused therapy program. Patients in the cognitive condition showed greater improvement in interpersonal problems than patients in the treatment as usual condition. Although this quasi-experimental study has serious limitations, the results may indicate that agoraphobic patients with Cluster C traits should be treated in cognitive agoraphobia and schema-focused programs rather than in psychodynamic treatment as usual programs in order to reduce their level of interpersonal problems.     

Societal Burden of Clinically Anxious Youth Referred for Treatment: A Cost-of-illness Study

A prevalence-based cost-of-illness study using a societal perspective was conducted to investigate the cost-of-illness in clinically anxious youth aged 8–18 in The Netherlands. Discriminant validity of the cost diary used was obtained by comparing costs of families with an anxious child (n = 118) to costs of families from the general population (n = 41). To examine the convergent validity, bottom-up acquired costs derived from cost diaries were compared to top-down acquired costs obtained from national registrations. Bottom-up acquired costs measured by means of cost diaries amounted to €2,748 per family of a clinically referred anxious child per annum. Societal costs of families with clinically anxious children were almost 21 times as high compared to families from the general population. With respect to convergent validity, total health care costs using the bottom-up approach from clinically anxious children were quite comparable to those of top-down data of anxious children, although costs within the subcategories differed considerably. Clinical anxiety disorders in childhood cost the Dutch society more than 20 million euros a year. Based on results of discriminate and convergent validity, the cost diary seems a valid method in establishing cost-of-illness in childhood anxiety disorders.     

A Multivariate Genetic Analysis of Specific Phobia, Separation Anxiety and Social Phobia in Early Childhood

BACKGROUND: Comorbidity amongst anxiety disorders is very common in children as in adults and leads to considerable distress and impairment, yet is poorly understood. Multivariate genetic analyses can shed light on the origins of this comorbidity by revealing whether genetic or environmental risks for one disorder also influence another. We examined the genetic and environmental influences on the comorbidity between three common childhood anxiety disorders: Specific Phobia, Separation Anxiety and Social Phobia. METHODS: Using a two-phase design 4,662 twin-pairs were screened in the first phase and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria. RESULTS: Multivariate genetic analysis revealed significant shared environmental over-lap between Specific Phobia and Separation Anxiety and significant familial and non-shared environmental over-lap between Specific Phobia and Social Phobia. CONCLUSIONS: Familial influences, especially shared environment, are central to the comorbidity between Specific Phobia and both Separation Anxiety and Social Phobia.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Cognitive processing of body and appearance words as a function of thin-ideal internalization and schematic activation

To better understand how women at risk of body image disturbance respond when their body concerns are activated, we examined attentional and memory biases in undergraduate women with high thin-ideal internalization, an identified risk factor for eating disorders, following priming of body and appearance concerns. Female undergraduates (N = 186) viewed photos of either sports cars or attractive swimsuit models, then completed the Lexical Decision Test, a word recall test, and questionnaires assessing thin-ideal internalization and eating disorder symptomatology. High thin-ideal internalizers did not exhibit cognitive biases predicted by cognitive models of eating disorders, even when their body and appearance concerns were primed by exposure to attractive models. Converging evidence suggests that high-risk non-clinical samples rarely exhibit cognitive biases characteristic of individuals with eating disorders, and, in fact, may actually incorporate ideal appearance into their schemas and preferentially attend to attractive stimuli.     

Academic Performance of Students with Emotional and Behavioral Disorders Served in a Self-Contained Setting

This study describes the academic, social, and behavioral performance of elementary and secondary students with emotional and behavioral disorders (EBD) receiving services in a self-contained school for students with serious behavior problems, with an emphasis on how school adjustment and problem behavior patterns predict academic performance. Results revealed that elementary and secondary group scores were well below the 25th percentile on reading, math, and written expression measures. Further, a seven variable model representing academic, social, and behavioral domains was able to differentiate between age groups explaining 54% of the variance and correctly classifying 78.26% (n = 18) of the elementary students and 84.21% (n = 16) of the secondary students. Findings also suggested that behavioral variables (e.g., school adjustment, externalizing, and internalizing) were predictive of broad reading and broad written expression scores, with school adjustment (a protective factor) accounting for the most variance in the three-variable model. Limitations and recommendations for future research are addressed.     

Comparing Brief and Extended Wait-Time During Small Group Instruction for Children with Challenging Behavior

This preliminary study compared brief (1 s) and extended (4 s) wait-time on response opportunities, academic responses, accuracy, and disruptive behavior of two children with challenging behavior during small group instruction. Brief wait-time increased children’s response opportunities, academic responses, and accuracy in comparison to extended wait-time. Though variable, brief wait-time also decreased children’s disruptive behavior. Findings differ from previous research, which found performance improvements with extended wait-time for children with moderate to profound cognitive disabilities. Limitations of the study and future research suggestions are discussed.     

Convergent Validity with the BERS-2 Teacher Rating Scale and the Achenbach Teacher’s Report Form: A Replication and Extension

In the present study, we sought to extend instrument validation research for a strength-based emotional and behavior rating scale, the Teacher Rating Scale of the Behavior and Emotional Rating Scale-Second Edition (BERS-2; Epstein, M. H. (2004). Behavioral and emotional rating scale (2nd ed.). Austin, TX: PRO-ED) through the use of convergent validation techniques. The associations between the strength-based domains of the BERS-2 were examined in relation to problem syndrome subscales of the Teacher’s Report Form (TRF; Achenbach, T. M. (1991b). Manual for the teacher’s report form and 1991 profile. Burlington: University of Vermont, Department of Psychiatry). Both measures were conducted with 58 students with emotional disturbance in grades 2 through 12. The overall convergent validity of the BERS-2 and the TRF was strong, particularly for TRF externalizing problems and associated syndromes. However, less evidence emerged for the convergence of domain subscales characterized by behaviors of an internalizing nature. These results provide further support for the use of the BERS-2 in the assessment of the social and behavioral functioning of students with emotional disturbance.     

Clinically Referred ODD Children with or without CD and Healthy Controls: Comparisons Across Contextual Domains

This study compares 6–11-year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder, either with (ODD + CD, n = 40) or without Conduct Disorder (ODD only; n = 136), to a matched sample of healthy control children (HC; n = 69). Multiple informants completed intake diagnostic interviews and self-reports to evaluate constructs examining the child’s functioning and contextual influences on functioning (e.g., parent, family, peer, community). ODD + CD and ODD only children were each distinguished from HCs by greater exposure to delinquent peers and lowered parental self-efficacy. In further comparisons to the HC group, ODD only status was associated with parental use of psychological aggression and more stressful life events, whereas ODD + CD status was associated with greater parental hostility. Relative to ODD alone status, ODD + CD status was comparable on all but one variable (greater parental hostility). Similar findings were reported using a subset of girls only. The characteristics that distinguish children with DBDs from controls and, in particular, ODD + CD from ODD only, bear implications for understanding and treating both CD and ODD.

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Family-based Psychoeducation for Children and Adolescents with Mood Disorders

Psychoeducation is often used for family members of adult patients with mood disorders. An increase in family’s knowledge of the patient’s illness course and outcome is thought to improve treatment compliance and may reduce relapse rates through identification of early symptoms and risks. While studies on family-based psychoeducation of adult patients with mood disorders have been reviewed, a similar review has not been conducted in patients who are children and adolescents. We conducted a systematic review of studies published between 1980 and 2006 on independently standing psychoeducation programs for families with children suffering from mood disorders. Results revealed eight treatment and preventive psychoeducation studies for families of affectively ill children or children at risk for depression. Findings indicate that psychoeducation models typically adopt a workshop approach incorporating didactic teachings and interactive discussion sessions, with or without specific skills training. Given the paucity of randomized controlled trials and lack of comparability between psychoeducation models, conclusions about the true efficacy of each program as a treatment or an adjunct to the treatment of mood disorders in children and adolescents cannot be made. Further research into psychoeducation for families of children with mood disorders is warranted.