Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents

Research on Child and Adolescent Psychopathology - The purpose of this study was to identify items from the Revised Children’s Anxiety and Depression Scale – RCADS-C/P that provided a...     

Relations of Tripartite Dimensions of Emotion to Childhood Anxiety and Mood Disorders

This study examined preliminary higher-order models relating tripartite dimensions of emotion to severity of anxiety and depressive disorders in 100 clinically referred children and adolescents. In light of the accumulating support for multifactor models of vulnerability and negative emotion in children, the present investigation was designed to establish preliminary estimates of the structure and magnitude of the relations of three emotion factors with dimensions of social anxiety, depression, panic, generalized anxiety, obsessions/compulsions, and separation anxiety. Results were consistent with structures that minimally specified two higher-order emotion factors, yet only some parameter estimates were consistent with theory regarding the tripartite model. Problems with the measurement of tripartite factors and possibilities for further research are outlined.     

Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS) in a clinical sample of 513 youth referred for mental health assessment at a university clinic. Internal consistency and factor analysis provided support for the factorial validity of the RCADS. Convergent and discriminant validity tests against both clinical interview and self-report criteria also suggested favorable properties of the RCADS. In comparative tests with traditional measures of anxiety and depression, the RCADS generally showed greater correspondence to specific diagnostic syndromes. Clinical cutoffs are reported for the purposes of future clinical and research applications.     

Factors affecting the reliability of clinical judgments about the function of children's school-refusal behavior.

Conducted two studies to examine the interrater reliability, test-retest stability, and the effect of various clinician variables, such as years of clinical experience, theoretical orientation, and prior experience with children, on clinical judgments about the reinforcement functions of children's school-refusal behavior. Results indicated that the judgments by individual clinicians were of questionable reliability. Judgments aggregated across 3 clinicians yielded acceptable interrater and test-retest reliability in Study 1, but a greater number of clinicians were necessary to achieve acceptable reliability in Study 2. Years of clinical experience and training were the only clinician variables related to the reliability of judgments about reinforcement functions. Several recommendations for the clinical assessment of the function of children's school-refusal behavior are discussed.     

A Multi-informant Multi-Measure Approach to the Two Factor Model of Emotion with Youth

The two-factor model of emotion clarifies the complexities of the relationship between anxiety and depression through their varying associations with positive and negative affect. Although this model’s structure has been studied in children, the lack of parent report measures on model-specific constructs has thus far prevented a multi-informant perspective on the model. Capitalizing on recent advancements in parent report assessment instruments, the present investigation aimed to confirm the two-factor model of emotion per child self-report; expand the model’s applicability to include parent report; and create a combined-informant model with a large number of parent-child dyad pairs (N?=?610). Structural equation modeling demonstrated good fit within parent and child informant models, but diminished fit for the multi-informant model. These results suggest a high degree of robustness with respect to informant type. Implications for the integration of multi-informant assessment information are discussed.     

Penn State Worry Questionnaire: Findings Form Normative and Clinical Samples in Denmark

Anxiety disorders are among the most prevalent psychiatric disturbances in childhood. None-the-less, they often go unrecognized and untreated, which puts the child at risk for developing additional difficulties, such as academic difficulties, depression, and substance abuse. Further knowledge and valid assessment tools are essential to identify at-risk children. The present study investigates (i) the factor structure of the Penn State Worry Questionnaire for Children (PSWQ-C) using a large Danish community sample (N?=?933), and (ii) its treatment sensitivity in clinically anxious children (N?=?30) treated with cognitive behavioral therapy. Results from the community sample replicated previous findings supporting the strong psychometric properties of the PSWQ-C, and yielded Danish norms and clinical cut-offs for the measure. Clinically anxious children with a generalized anxiety disorder (GAD; N?=?10) diagnosis reported significantly higher levels of worry than anxious children without GAD (N?=?20). At post treatment, worry levels in children with GAD but not in anxious children without GAD were normalized. Findings regarding worry in the community sample are discussed in light of normal child development. Implications for the use of the PSWQ-C as a useful and important tool in clinical assessment by psychiatrists and psychologists in their treatment of anxious children and adolescents are also discussed.     

A psychometric analysis of the Positive and Negative Affect Schedule for Children-Parent Version in a school sample

The current study was the 1st to examine the psychometric properties of the Positive and Negative Affect Schedule for Children-Parent Version (PANAS-C-P) using a large school-based sample of children and adolescents ages 8 to 18 (N = 606). Confirmatory factor analysis supported a 2-factor (correlated) model of positive affect (PA) and negative affect (NA). The PANAS-C-P scale scores also demonstrated acceptable internal consistency and convergent and divergent validity. The PANAS-C-P PA and NA scale scores also related to measures of anxiety and depression in a manner consistent with the tripartite model. Scale means and standard deviations were reported by grade and sex to provide normative data for the PANAS-C-P scales. Results from the present study provide initial support for the PANAS-C-P as a parent-reported perspective of youth PA and NA among school-based youths.