Treatment Effectiveness of PMTO for Children's Behavior Problems in Iceland: Child Outcomes in a Nationwide Randomized Controlled Trial

Well‐documented treatment methods must be tested following their implementation in community service agencies and across different cultures to ensure continuing effectiveness. This study was a randomized controlled trial (RCT) of Parent Management Training—the Oregon model (PMTO), conducted within a nationwide implementation in Iceland. Families of 102 clinically referred children with behavior problems were recruited from five municipalities throughout Iceland. Child age ranged from 5 to 12; 73% were boys. Families were randomly assigned to either PMTO or services usually offered in the communities (SAU). Child adjustment was measured with a latent construct based on parent, child, and teacher reports of externalizing and internalizing problems and social skills. Prepost intent‐to‐treat analyses showed that PMTO treatment led to greater reductions in child adjustment problems relative to the comparison group, obtaining a modest to medium effect size based on the construct score. Only one indicator (parent‐rated Social Skills) showed significant change independently and information on amount and kind of treatment in the SAU was limited. Overall, findings indicate that PMTO is an effective method to treat children's behavior problems in a Northern European culture and supply evidence for the method's successful implementation in community settings in Iceland. This is one of few nationwide implementation studies of PMTO outside the United States and the first RCT in Iceland to test a treatment model for children's behavior problems.     

The Predictive Utility of Narcissism among Childrenand Adolescents: Evidence for a Distinction betweenAdaptive and Maladaptive Narcissism

We examined the predictive utility of narcissism among a community sample of children and adolescents (N=98) longitudinally. Analyses focused on the differential utility between maladaptive and adaptive narcissism for predicting later delinquency. Maladaptive narcissism significantly predicted self-reported delinquency at one-, two-, and three-year follow-ups. This pattern held even when considering other intrapersonal risk factors for conduct problems (i.e., callous-unemotional traits, impulsivity), parenting practices, and when controlling for earlier conduct problems. In addition, adaptive narcissism was predictive of delinquency in the absence of positive parenting practices, with maladaptive narcissism being particularly predictive of delinquency in the presence of negative parenting. The implications for understanding delinquency in terms of the social and motivational characteristics that are the hallmark of maladaptive narcissism are discussed.     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

Effects of Extracurricular Participation on the Internalizing Problems and Intrapersonal Strengths of Youth in a System of Care

Although extracurricular participation has been linked to positive youth outcomes in the general population, no research to date has examined benefits for youth diagnosed with mental health challenges. Youth in systems of care (SOCs) receive a variety of services and supports that could help them capitalize on this potential for positive development, such as access to flexible funding to support recreational interests. However, research has not examined the degree to which the increased community involvement (e.g., extracurricular participation) sought in SOCs contributes to improved outcomes. This study addresses these gaps by investigating the relationships between both average and increased extracurricular participation frequency and breadth and internalizing problems and intrapersonal strengths among SOC youth. Findings revealed that, on average, higher frequency of youth participation was associated with higher intrapersonal strengths and lower internalizing problems. Increases in participation frequency were also associated with increased strengths and decreased internalizing problems. These findings suggest that efforts to implement supports for increasing extracurricular participation of SOC youth could improve their psychosocial outcomes beyond the benefits yielded via formal services. Taken together, these results provide support for advocacy efforts to integrate youth with mental health challenges into existing extracurriculars and to create new extracurricular opportunities.     

Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training—the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.     

Some Oedipal problems in work with adopted children and their parents

This paper has two main theses. Firstly that Oedipal material is a particular feature of clinical work with adopted children; secondly, that the concept of developmental deficit, and not only that of psychic defence, is essential to an understanding of this aspect of the work with adopted children and their families. Three levels are distinguished at which Oedipal difficulties are manifest: the first two within the individual child and the third within the triangle formed by the child, his adoptive parents and the child psychotherapist. Some consideration is given to the limitations of a conventional treatment framework for containing the powerful Oedipal dynamic forces at play when an adopted child is a patient in individual psychotherapy. Dieser Artikel hat zwei Hauptthesen. Erstens, dass ödipales Material ein besonderes Merkmal der klinischen Arbeit mit adoptierten Kindern ist; zweitens dass das Konzept eines Entwicklungsdefizit, und nicht nur das eines psychischen Abwehrmechanismus, für das Verstehen dieses Aspekts der Arbeit mit adoptierten Kindern und ihren Familien unerlässlich ist. Es werden drei Stufen differenziert, in denen sich ödipale Schwierigkeiten manifestieren: die ersten zwei innerhalb des Kindes und die dritte innerhalb des Dreiecks, das vom Kind, seinen Adoptiveltern und dem Kindertherapeuten gebildet wird. Es werden überlegungen bezüglich der Grenzen des konventionellen Behandlungsrahmens angestellt, inwieweit er die mächtigen ödipalen dynamischen Kräfte, die im Spiel sind, 'containen' kann, wenn ein adoptiertes Kind Patient in individueller Psychotherapie ist. Dans son texte, l'auteur développe deux thèses principales: d'abord, que le matériel ?dipien est d'une importance particulière dans le traitement d'enfants adoptés; et, ensuite, que le concept de trouble déficitaire du développement, en plus de celui de défense psychique, est essentiel pour comprendre cet aspect de la prise en charge d'enfants adoptés et de leur famille. L'auteur distingue trois niveaux auxquels se manifestent la problématique ?dipienne?:?les deux premiers concernent l'enfant lui-même en tant qu'individu, le troisième renvoie au triangle composé de l'enfant, de ses parents adoptifs et du psychothérapeute. Certaines limitations imposées par le cadre thérapeutique traditionnel sont ensuite explorées, notamment par rapport à la possibilité de contenir la puissante dynamique ?dipienne évoquée dès qu'un enfant adopté est pris en psychothérapie individuelle. Questo articolo sostiene due tesi principali. La prima e' che il materiale edipico e' una caratteristica particolare del lavoro clinico con bambini adottati; la seconda e' che il concetto di deficit evolutivo, e non solo quello di difesa psichica, e' essenziale per capire questo aspetto del lavoro con bambini adottati e le loro famiglie. Vengono distinti tre livelli in cui si manifestano le difficolta' edipiche: i primi due all'interno del singolo bambino, il terzo all'interno del triangolo formato dal bambino, dai suoi genitori adottivi e dallo psicoterapeuta infantile. Vengono fatte alcune considerazioni sulle limitazioni che il contesto terapeutico convenzionale ha nel contenere le potenti forze dinamiche edipiche in gioco quando un bambino adottato diventa paziente in terapia individuale.     

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.     

Utilizing Family Strengths and Resilience: Integrative Family and Systems Treatment with Children and Adolescents with Severe Emotional and Behavioral Problems

Community mental health agencies are consistently challenged to provide realistic and effective home-based family-centered treatment that meets local needs and can realistically fit within available budget and resource capabilities. Integrated Family and Systems Treatment (I-FAST) is developed based on existing evidence-based approaches for working with at-risk children, adolescents, and families and a strengths perspective. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol; this is done in a way that builds on and is integrated with mental health agencies' existing expertise in home-based treatment. This is an intervention development study in which we conducted an initial feasibility trial of I-FAST for treating families with children at risk of out-of-home placement. The outcomes of the study provide initial empirical evidence that supports the effectiveness of I-FAST. Findings indicate that there were significant improvements in child behavior, significant increases in parental competency, and significant increases in the level of cohesion and adaptability in these families. All observed changes were significant from pre- to posttreatment with the families able to maintain these positive changes at 6-month follow-up. A more rigorous and robust research design, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.     

Task‐Related Factors that Influence the Spontaneous Use of Diagrams in Math Word Problems

Diagrams are effective tools for problem solving. However, previous findings indicate that students generally do not use diagrams spontaneously. This study examined task‐related factors that may influence the spontaneity of diagram use. Experiment 1 compared two possible explanations: the first, that the length‐relatedness of the story context of the problem (i.e. whether it involves the measurement of length) determines the likelihood of diagram use; and the second, that the cognitive cost of transforming the situation described in the word problem to an abstract diagrammatic representation is the more important factor. Four math word problems, differing in their story context and structure, were administered to eighth‐grade Japanese students (n = 125) to solve. The results provide support for the cognitive transformation cost explanation. The results of experiment 2, in which the problems were administered to students in both Japan (n = 291) and New Zealand (n = 323), confirm this finding. Copyright © 2011 John Wiley & Sons, Ltd.