Treatment Adherence in Children with Sickle Cell Disease: Disease-Related Risk and Psychosocial Resistance Factors

To identify disease-related risk factors and psychosocial resistance factors that impact adherence to prescribed treatment in the context of admission to a Hematology Acute Care Unit (HACU) designed to provide acute care for children with sickle cell disease (SCD) presenting with pain or fever. A total of 73 primary caregivers and 24 children (if age 8 or older) completed standardized forms during the HACU admission. Treatment adherence variables (medical staff rating, SCD-related care activities, percentage of agreement between treatment recommendations made and care activities, and attendance at hematology clinic) indicated moderate-to-high adherence. Based on regression analyses, the risk variable of disease-related stress and the resistance variables of family flexibility and less reliance on passive coping accounted for significant portions of the variance in treatment adherence. Empirical evaluation of interventions designed to improve communication regarding expectations for the care of children with SCD and to support active family problem solving during times of SCD-related stress must be ongoing.     

Helping Children Access and Use Services: A Review

High rates of dropping out from mental health services are documented for children and their families. These high rates exist at different treatment stages, in different service settings, and for different populations of children and families. Some researchers have developed and tested engagement interventions to address barriers to service access and use and increase participation in services by children and their families. Studies of engagement interventions for children and their families are critically reviewed in this paper. Overall, the engagement interventions were effective in increasing attendance at first appointments. Only those with an ecological and total service delivery approach reduced the drop-out rate. However, even then, the drop-out rate was 26% to 29%. Suggestions for future research are made, including ascertaining from children and families their reasons for quitting or staying in treatment, comparing the outcomes of drop-outs with the outcomes of those who remain in treatment, developing and testing conceptual models of engagement for subgroups of at-risk children and their families, and examining the cost-effectiveness of engagement interventions.     

Treatment Foster Care in a System of Care: Sequences and Correlates of Residential Placements

We examined Treatment Foster Care (TFC) in residential trajectories for youth with psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care.     

A linear growth curve analysis of inpatient treatment response by conduct‐disordered,ADHD, and comorbid preadolescents

Conduct disorder (CD) comorbid with attention deficit hyperactivity disorder (ADHD) is widely reputed to be treatment refractory, particularly when accompanied by aggression and early‐onset symptoms. Few studies, however, have assessed inpatient treatment response among early onset CD/ADHD children in detail. In the present investigation, behavioral and rating scale data were compared among CD (n=13), ADHD (n=20), and CD/ADHD (n=45) preadolescents during one‐month of multimodal inpatient treatment that included methylphenidate administration. As expected, linear growth curve analyses revealed that CD/ADHD children were the most symptomatic of the three groups. However, all groups benefited from hospitalization, with few differences in treatment responsiveness observed. Analyses of residualized symptoms suggested that methylphenidate administration was effective in curbing impulsive but not aggressive behaviors. Aggr. Behav. 29:440–456, 2003. © 2003 Wiley‐Liss, Inc.     

Barriers to evidence-based treatment: developmental psychopathology and the interdisciplinary disconnect in school mental health practice

Reframing the role of school psychologists and related school professionals in a public health and primary prevention model represents a proactive antidote to their more traditional reactive stance to mental health problems. Two additional concepts, developmental psychopathology and complex comorbidity, are suggested as critical to complete this transition, and illustrations of these concepts for more effective school mental health services are provided.     

Personality characteristics of women with alcohol addiction: A Rorschach study of women in an early treatment programme

This study identifies personality characteristics in a group of Swedish women (N=60) attending their first treatment for alcohol problems.The treatment programme specifically addressed women in an early phase of their drinking career, and was called "Early Treatment of Women with Alcohol Addiction" (EWA). Rorschach personality profiles of the 60 women differed significantly in almost all investigated aspects in a psychopathological direction from norms reported by Exner for a reference group of female non-patients. The findings are consistent with the assumption that, although the EWA women were socially well-functioning and fairly early in their drinking career, they nevertheless reveal serious underlying psychopathology. Clinical implications of the findings are discussed.     

Personality characteristics in primary benzodiazepine-dependent patients: Comparison with controls and polydrug users

The present study applied Karolinska Scales of Personality (KSP) to study (i) if patients with benzodiazepine dependence have a characteristic personality profile, (ii) if the personality characteristics in patients with benzodiazepine dependence differ from those of polydrug users and normal controls, (iii) if differences in treatment outcome existed between the groups, and (iv) if the possible difference in treatment outcome was associated with any particular personality characteristic shown by the patients. The personality characteristics of primary benzodiazepine dependent patients (BDZ) and a group of polydrug users (MIX) were studied initially (during the first week in project as an inpatient) and approximately one year after drug discontinuation, and a comparison was made with healthy controls on both test occasions. The results showed that the personality of both groups of patients differed significantly from the Controls in the following characteristics: Detachment, Socialization, Somatic Anxiety, Muscular Tension, Psychic Anxiety, and Psychasthenia. Significant differences existed between the polydrug and benzodiazepine users in Somatic and Psychic Anxiety as well as in Socialization. The MIX group differed significantly from the BDZ group and from the Controls in Suspicion. Results of treatment outcome indicated that the benzodiazepine dependent patients were significantly more successful in quitting their drug use compared to polydrug users. Further, the results demonstrated that patients scoring high in the investigated personality characteristics are those who fail the treatment goal of quitting their drug use, especially the patients with a high level of anxiety and detachment.     

Persistence of acquired behavioral control in the context of imprinting

Newly hatched Khaki Campbell ducklings (Anas platyrhynchos domesticus) were exposed to a moving object that immediately suppressed distress vocalizations occurring in a novel environment. The static visual and auditory features of this object acquired the ability to suppress distress vocalizations after eight 20-min sessions of exposure to the object in motion. The acquired suppressive properties of these features were found to persist throughout thirty 20-min sessions given over 10 days. During these sessions, the ducklings were continually exposed to the static features in the absence of visual movement. In a second experiment, the ability of these features in the absence of visual movement. In a second experiment, the ability of these features to serve as reinforcement for a pecking response was shown to persist for up to 56 hr. In one duckling, presentations of the static visual features did not maintain pecking behavior. However, it was shown that pecking responses could be re-instated in this duckling by introducing novel stimuli to the environment.     

Time-Varying Treatments in Observational Studies: Marginal Structural Models of the Effects of Early Grade Retention on Math Achievement

One of the main objectives of many empirical studies in the social and behavioral sciences is to assess the causal effect of a treatment or intervention on the occurrence of a certain event. The randomized controlled trial is generally considered the gold standard to evaluate such causal effects. However, for ethical or practical reasons, social scientists are often bound to the use of nonexperimental, observational designs. When the treatment and control group are different with regard to variables that are related to the outcome, this may induce the problem of confounding. A variety of statistical techniques, such as regression, matching, and subclassification, is now available and routinely used to adjust for confounding due to measured variables. However, these techniques are not appropriate for dealing with time-varying confounding, which arises in situations where the treatment or intervention can be received at multiple timepoints. In this article, we explain the use of marginal structural models and inverse probability weighting to control for time-varying confounding in observational studies. We illustrate the approach with an empirical example of grade retention effects on mathematics development throughout primary school.