The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

I am happy in my faith: the influence of religious affiliation,saliency, and practice on depressive symptoms and treatment preference

Religion is thought to significantly impact numerous areas of mental health, including depression. Using a 63-item questionnaire, the influence of religious affiliation, saliency, and practice on levels of depressive symptoms and treatment preference in a non-clinical sample of Christians, Muslims, Atheists, and Agnostics (N = 471) was investigated. No significant differences in depressive symptoms were found between affiliations. Saliency and frequency of practice had a weak negative correlation with depressive symptoms for Christians, but were not significant for Muslim participants. No significant differences of preference were found between affiliations for social, cognitive, and medical treatments. Treatment preference of religious-based treatments differed significantly between affiliations. Findings suggest that affiliation is not significantly related to depressive symptoms or treatment preference, and the influence of saliency and practice differs between religions. Limitations and implications of the current study are discussed, and directions for further research are identified.     

Hispanic use of juramentos and Roman Catholic Priests as auxiliaries to abstaining from alcohol use/misuse

This self-administered mail survey study conducted along the US–Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priests indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.     

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.     

自我保护性医疗的伦理扫描--论患方知情同意与医方规避风险

自我保护性医疗是近年来医方为应对医患关系重构而采取的一种行为模式,其本身和影响具有全新特点,充满价值冲突;这种行为模式,客观上是对应医疗风险尤其是重大医疗风险的;主观上同医方免责期待的张扬以及对知情同意的解读直接相关;因而,正当的自我保护性医疗既取决于医方合理的免责期待,以及改变对知情同意的误读,更依赖于自身的医学伦理综合素质的打造和完善。     

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.