Placebo in the investigation of psychotropic drugs,especially antidepressants

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Adolescent adjustment and well-being: effects of parental divorce and distress

This study investigates the long-term effects of parental divorce on adolescent psychological adjustment and well-being, and to what extent the effects are accounted for by parental psychological distress. Data were collected among 8,984 Norwegian adolescents (13-19 years) and their parents. Outcome variables were symptoms of anxiety and depression, subjective well-being, and three areas of school problems. Parental divorce was found to be associated with both higher mean levels and larger variances in adolescent problems. Divorce and parental distress contributed independently to adolescent distress, supporting the notion of "double exposure" effects. The prevalence of adolescents with substantial distress symptoms was 14% among those with non-distressed non-divorced parents and 30% among those with divorced and distressed parents. In general effects remained when controlling for demographic factors. Long-term effects of divorce on symptoms of anxiety and depression were stronger among girls than among boys.     

Callous-unemotional traits and conduct problems in the prediction of conduct problem severity,aggression, and self-report of delinquency

The role of callous-unemotional (CU) traits and conduct problems in predicting conduct problem severity, severity and type of aggression, and self-reported delinquency at a 1-year follow-up was investigated in a sample of 98 children (mean age 12.43; SD = 1.72) recruited from a community-wide screening. Children with both CU traits and conduct problems had a greater number and variety of conduct problems at follow-up than children who at the screening had high levels of conduct problems alone. However, this poorer outcome for children with CU traits could largely be accounted for by differences in initial level of conduct problem severity. Children with CU traits and conduct problems were also at risk for showing higher levels of aggression, especially proactive aggression, and self-reported delinquency. Importantly, these outcomes could not be solely explained by initial level of conduct problem severity. Finally, CU traits predicted self-reported delinquency in some children who did not initially show high levels of conduct problems and this predictive relationship seemed to be strongest for girls in the sample who were high on CU traits but who did not show significant conduct problems.     

Going home: the complex effects of reunification on internalizing problems among children in foster care

When children in foster care are reunified with their families of origin they encounter changes that may influence their well-being in both positive and negative ways. We examined the effects of reunification among 218 children in foster care to test an integrative model of the effects of reunification using structural equation modeling. We hypothesized that reunification would exert indirect effects on subsequent child adjustment via changes in adverse life events, perceived social isolation, and mental health service utilization. Results indicated no direct effect of reunification on subsequent internalizing problems, but reunification was related to increased adverse life events that, in turn, were related to elevated symptoms. Second, reunification was negatively associated with mental health service use. Finally, reunification was associated with decreased child perceptions of social isolation. In summary, reunification with biological parents is associated with multiple environmental changes, with most but not all effects indicating negative consequences.     

Neighborhood structure,parenting processes,and the development of youths' externalizing behaviors: a multilevel analysis

Associations among neighborhood structure, parenting processes, and the development of externalizing behavior problems were investigated in a longitudinal sample of early adolescents (from age 11 to 13). Mothers' reports of parental monitoring (at age 11), mothers' and youths' reports of the amount of youths' unsupervised time (at age 11), and youths' reports of positive parental involvement (at age 12) were used to predict initial levels (at age 11) and growth rates in youths' externalizing behavior as reported by teachers. Census-based measures of neighborhood structural disadvantage, residential instability, and concentrated affluence were expected to moderate the effects of parenting processes (e.g., parental monitoring) on externalizing behavior. Hierarchical linear modeling results revealed that less parental monitoring was associated with more externalizing behavior problems at age 11, and more unsupervised time spent out in the community (vs. unsupervised time in any context) and less positive parental involvement were associated with increases in externalizing behavior across time. Furthermore, the decrease in externalizing levels associated with more parental monitoring was significantly more pronounced when youths lived in neighborhoods with more residential instability.     

The Infant–Toddler Social and Emotional Assessment (ITSEA): Factor Structure, Reliability, and Validity

In this paper the refinement and psychometric properties of the Infant–Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence domains as well as the 17 individual scales that comprise the ITSEA. Findings for 3 additional indices useful in identifying significant psychopathology are presented. Subgroup analyses revealed structural invariance and expected mean level differences across both child sex and 6-month age bands. Child sex differences emerged for some problem and most competence scales, with boys rated as higher on Activity–Impulsivity and girls rated higher on Anxiety and most Competence scales. All competence scores increased across age groups. Problem behaviors showed a more mixed developmental pattern. Test–retest and interrater reliability were acceptable. Associations between the ITSEA and independent evaluator ratings and parental ratings of child behavior problems, temperament, and parental distress support the validity of the instrument.     

The Effects of Children's Exposure to Domestic Violence: A Meta-Analysis and Critique

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Z _r = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.     

Pathways Between Social Support,Family Well Being,Quality of Parenting,and Child Resilience: What We Know

We contribute to the theoretical and research knowledge base regarding the pathways between parental social support, family well being, quality of parenting, and the development of child resilience in families with a child with serious emotional problems. Little conceptual development has been done that provides a theoretical framework for studying the relationships among these variables. We identify key findings from social support theory and research, including the impact of social support on family well being and the parents’ capacity to parent, and the experience of parental social support in families with a child with a disability. We review the constructs of family well being, quality of parenting, and child resilience. Further, we explain the pathways between parental social support, family well being, quality of parenting, and child resilience in families with a child with serious emotional problems. Key variables of the model and the nature of their inter-relationships are described. Social support is constructed as a protective mechanism with main and buffering effects that can impact family well being, quality of parenting, and child resilience at a number of junctures. The conceptual model’s implications for future theory development and research are discussed.     

Community Involvement in Adapting and Testing a Prevention Program for Preschoolers Living in Urban Communities: ParentCorps

We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.     

Taxonomic Examination of ADHD and Conduct Problem Comorbidity in Elementary School Children Using Cluster Analyses

Cluster analysis was used to investigate the classification of comorbid Attention Deficit Hyperactivity Disorder (ADHD) +Conduct Problems (CP). Teachers rated 1394 elementary school children on symptoms of inattention, hyperactivity/impulsivity, opposition, and conduct problems using the ADS-IV behavior-rating scale. Results suggested that a seven-cluster solution, including two distinct comorbid clusters, was the most appropriate method of classifying children according to behavioral symptoms. A one-way MANOVA showed that overall cluster profiles differed significantly from each other, whereas one-way ANOVAs indicated that clusters differed on age and symptom scores. Chi-square analyses indicated that clusters differed on gender. Post hoc analyses and effect sizes calculations revealed that the comorbid clusters differed from each other and from their single-disorder counterparts on some variables, but not on all. These results provide support for an additive conceptualisation of ADHD +CP.