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Objective: To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics., Setting: Outpatients referred to medical or community-based facilities in a region of France., Participants: One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury)., Design: Cross-sectional cohort study., Main Measures: Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI)., Results: Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS., Conclusion: Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and β-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.

Background: Low- and middle-income countries often lack the fiscal, infrastructural and human resources to conduct evidence-based research; similar constraints may also hinder the application of good clinical practice guidelines based on research findings from high-income countries. While the context of health organizations is increasingly recognized as an important consideration when such guidelines are implemented, there is a paucity of studies that have considered local contexts of resource-scarcity against recommended clinical guidelines., Methods: This paper sets out to explore the implementation of the NICE Guideline 11 on family interventions when working with persons with intellectual disability and challenging behavior by a group of psychologists employed in a government health facility in Cape Town, South Africa., Results: In the absence of evidence-based South African research, we argue that aspects of the guidelines, in particular those that informed our ethos and conceptual thinking, could be applied by clinical psychologists in a meaningful manner notwithstanding the relative scarcity of resources., Conclusion: We have argued that where guidelines such as the NICE Guidelines do not apply contextually throughout, it remains important to retain the principles behind these guidelines in local contexts. Limitations of this study exist in that the data were drawn only from the clinical experience of authors. Some of the implications for future research in resource-constrained contexts such as ours are discussed. Smaller descriptive, qualitative studies are necessary to explore the contextual limitations and resource strengths that exist in low- and middle-income settings, and these studies should be more systematic than drawing only on the clinical experience of authors, as has been done in this study.

Primary Objective: Patients with traumatic brain injury (TBI) have difficulty dealing with the social world and may display inappropriate social behavior that negatively affects their social and occupational rehabilitation. This difficulty may be explained by a social problem-solving (SPS) impairment, but little is yet known about the cognitive processes involved in the ability to solve social problems. Several publications have demonstrated that executive functions are related to social problem solving, but the role of social cognition needs to be confirmed. The present pilot study examined the expected relationships between SPS ability and both social cognition and social behavioral skills., Research Design: We compared the performances of 15 patients with TBI on SPS, theory-of-mind and social behavior tasks with those of 25 matched healthy controls., Main Outcomes and Results: Our results showed for the first time that impaired social problem solving is associated with a theory-of-mind deficit, but surprisingly not with executive impairment. There was no evidence that SPS deficits predict social behavioral disorders., Conclusions: Studying social problem solving in patients with TBI may inform the design of more appropriate methods of social rehabilitation.

Background: Children living in low-resource communities are at risk for poorer socio-emotional development and academic performance. Emerging evidence supports use of group music therapy experiences to support social development through community afterschool programming., Objective: To examine the potential benefit of a music therapy social skills development program to improve social skills and academic performance of school-aged children with limited resources in an afterschool program., Method: We used a single-group pre/post-test design, and recruited 20 students (11 females, 9 males), ages 5 to 11 years, from an afterschool program. The music therapy social skills program consisted of eight 50-minute sessions, and we measured social competence and antisocial behavior using the Home & Community Social Behavioral Scale (HCSBS; Merrell & Caldarella, 2008), and social skills, problem behaviors, and academic competence using the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008a, 2008b)., Results: Only students who attended a minimum of six sessions (N = 14) were included in data analysis. Results showed no significant change in individual HBSC subscale scores; however, the total number of low-performance/high-risk skills significantly decreased. SSIS teacher results indicated significant improvement in communication, significant decrease of hyperactivity, autistic behavioral tendencies and overall problem behaviors, and marginal decreases in internalization. Parent ratings mirrored, in part, those of the teacher., Conclusions: Results indicated that music therapy has the potential of being an effective intervention for promoting social competence of school-aged children with limited resources, particularly in the areas of communication and low-performance/high-risk behaviors. Teaching skills through song lyrics and improvisation emerged as salient interventions.

Social behaviour disorders in traumatic brain injury are caused by the dysfunction of cognitive processes involved in social and interpersonal interaction. The concept of social cognition was introduced by authors studying schizophrenia, autism or mental retardation. The boundaries and the content of the concept have not yet been definitively defined, but theory of mind, empathy and emotional processing are included in all the models proposed. The strategies proposed to improve social behaviour focus on the restoration of cognitive processes such as working memory, emotional recognition and processing, and empathy, as well as social skills. To date, there is very little evidence on the efficacy of the aforementioned social cognition strategies., (Copyright © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objective: This pilot study examined the effectiveness of a parent-delivered intervention for improving: the social play skills of children with attention deficit hyperactivity disorder (ADHD) and their typically developing playmates and the empathy of children with ADHD., Methods: Participants were children with ADHD and their typically developing playmates (n = 9/group). The intervention was primarily parent-implemented and involved: parent-training, weekly home-modules, three clinic play-sessions, therapist-parent phone consultations and a one-month follow-up. The Test of Playfulness (ToP) was the primary outcome measure. Cohen's-d and paired sample t-test calculations were used to measure effect., Results: Social play outcomes of children with ADHD improved significantly from: pre- to post-test (t = 3.2; p = 0.02; d = 1.0) and post-test to follow-up intervention (t = 2.7; p = 0.02; d = 1.1). Playmate's improved significantly from pre- to post-intervention (t = 3.9; p = 0.03; d = 1.2). Children with ADHD improved significantly on 4/7 ToP empathy items (t = 2.31-3.16; p = 0.02)., Conclusion: The intervention successfully improved the social play skills of children with ADHD and their playmates.

Individuals with autism spectrum disorder (ASD) have qualitative impairments in social interaction and often prefer food or tangible reinforcement to social reinforcement. Thus, therapists who work with children with ASD often use food or tangible items as reinforcers to increase appropriate behaviors or decrease problem behaviors. The goal of the present study was to shift children's preferences from a highly preferred tangible item to an initially nonpreferred social reinforcer using an observational conditioning procedure. Participants observed a known peer engage in a simple task and select the social reinforcer that was not preferred by the participant. This procedure resulted in a shift of preference toward the social reinforcer by all participants. Maintenance data showed that although the preference change did not maintain for 1 of the participants, it was quickly reestablished with additional observational trials. Results provide further support for the use of observational procedures to alter preferences., (© 2015 Society for the Experimental Analysis of Behavior.)

The welcomed coeducation of children and adolescents with and without disabilities is going into dangerous territory since it has become burdened with a number of illusionary expectations. The constraints applied by real-life and meaningful circumstances should be taken into account, especially for children with emotional and social behavior disorders. Practicable prevention and intervention measurements cannot be generated without profound knowledge about disorders among this heterogeneous group of people. Abandoning all previously relevant terminology («noncategorization»), demanded by some radical inclusion advocates, leads to a situation that is helplessly confronted with its duties but lacks the basic skills and the necessary support stemming from an interdisciplinary dialogue. The contact with child and adolescent psychiatry is threatened to the disadvantage of the profession.

Parkinson syndromes (PS) represent frequent neurodegenerative disorders. The demographic change suggests an increasing prevalence of PS in the near future. Treatment expenses, early retirement and need of long-term care result in rising public health care expenditures. Standardised concepts of care do not only improve the quality of patient-centered care, but also help to minimize its consequential costs. Their implementation requires profound knowledge of therapeutic strategies and sociomedical regulations. Medical treatment and sociomedical care have to be regularly reevaluated and adapted to the patient's needs and disease severity. An optimal therapy concept guarantees the patient's long term social integration and improves the compliance., (© Georg Thieme Verlag KG Stuttgart · New York.)

The JobFit-Training for adolescents (Petermann u. Petermann, 2010) is a well documented behavioural psychological prevention program for students from the eighth grade and up. The present study examines the results of the evaluation of the practical implementation of the training over the course of two years. Data from 828 students could be collected in two measurements, before and after the intervention, out of which 323 were eighth-graders and 505 were ninth-graders. The analysis showed that eighth-graders profit more with regards to acquiring knowledge through the training than ninth-graders do. However, unlike male eighth-graders, female eighth-graders were unable to furthermore improve their social competences through the training. On the other hand the ninth-graders profit from the training in both groups with regards to their social competences.

The self-regulation model (SRM) is a nine-phase, four-pathway offense process model designed specifically for sexual offenders that is now being applied to the treatment of this group in many settings and jurisdictions. In the present prospective study, we evaluated the validity and utility of the SRM in a sample of 275 adult male sexual offenders treated within the Correctional Service of Canada. Results indicated that participation in treatment resulted in moderate to large sized improvements from pretreatment to posttreatment on a dynamic risk assessment measure and several self-reported treatment targets. These changes were, in some cases, differentially associated with self-regulation pathways, suggesting that offense pathway is a clinically relevant variable when evaluating treatment change and in conceptualizing sexual offender treatment. In terms of outcome, individuals following the approach pathways, particularly the approach-automatic pathway, demonstrated higher failure rates than individuals following avoidant pathways. However, many of these differences were less pronounced when taking risk for recidivism into account. Implications of these findings for the effective assessment and rehabilitation of sexual offenders are discussed., (© The Author(s) 2013.)

We examined the use of risk-change information in sexual offender risk assessments featuring the Violence Risk Scale-Sexual Offender version (VRS-SO), a sex offender risk assessment and treatment planning tool. The study featured a combined international sample of 539 sex offenders followed up an average of 15.5 years post-release. Pre- and posttreatment VRS-SO ratings were amalgamated from two treated samples of sex offenders from Canada and New Zealand. Analyses focused on examinations and applications of change data and its relationship to sexual and violent recidivism. VRS-SO change scores were significantly associated with decreases in these outcome criteria with, and without, controlling for indicators of pretreatment risk (e.g., Static-99R score) and individual differences in follow-up time. Applications of logistic regression using fixed 5-year follow-ups generated estimated rates of sexual and violent recidivism at different VRS-SO score thresholds. The use of logistic regression demonstrated a clinically useful and systematic means of combining risk and change information into posttreatment risk appraisals. Implications for the use of change information in the assessment and management of sexual offender risk are discussed., (© The Author(s) 2013.)

This opinion piece considers my personal experiences of poverty, homelessness, loss, and physical disability in relation to recent discussions of social defeat and resistance among permanent supported housing tenants with physical and mental illnesses. By drawing attention to the onslaught of deprivation and humiliation that generally comes with the territory of poverty and homelessness in the United States, I hope to influence the ways in which clinicians, social service providers, and scholars think about specific instances of social defeat and resistance. My basic point is that any specific experience of resistance or defeat cannot be adequately understood in isolation. Rather, such experiences must be understood in relation to individual life histories of defeat and resistance, and to the symbolic and material sources of success and failure available to citizens who occupy a particular section of social space in a given society.

Objective: Exposure to antisocial others within treatment group sessions may have negative impact. We extend prior research with adolescents by examining rehabilitation group composition among adult male incarcerated offenders., Method: Data were gathered from institution files of rehabilitation completers (N = 1,832; M age = 33.5; 19% Aboriginal, 68% Caucasian), including general, substance, violent, and sex offenders. Capacities for treatment (including motivation, learning ability, and inhibitory control) were gathered from intake assessments. At the beginning and end of rehabilitation, providers rated program performance. Risk for recidivism and postrelease recidivism were gathered from official files, up to 3 years following release., Results: Group effects accounted for up to 40% of variance in program outcomes. Group features (average group participant risk to reoffend and risk score diversity) significantly interacted with treatment capacities to explain program outcomes. Most models revealed a dampening effect whereby the positive association between capacities and outcome was reduced in groups of higher risk and more risk diverse coparticipants. Group composition typically accounted for 30-38% of variance between groups, but total variance in outcome explained was generally small. Higher average group risk predicted postrelease recidivism among family violence offenders., Conclusions: Coparticipants should be considered when researching and providing group programs to adult offenders, with specific attention toward how positive outcomes may be attenuated in the presence of criminogenic coparticipants.

Background and Objectives: Social skills training (SST) intervention has shown its efficacy to improve social dysfunction in patients with psychosis; however the implementation of new skills into patients' everyday functioning is difficult to achieve. In this study, we report results from the application of a virtual reality (VR) integrated program as an adjunct technique to a brief social skills intervention for patients with schizophrenia. It was predicted that the intervention would improve social cognition and performance of patients as well as generalisation of the learned responses into patient's daily life., Methods: Twelve patients with schizophrenia or schizoaffective disorder completed the study. They attended sixteen individual one-hour sessions, and outcome assessments were conducted at pre-treatment, post-treatment and four-month follow-up., Results: The results of a series of repeated measures ANOVA revealed significant improvement in negative symptoms, psychopathology, social anxiety and discomfort, avoidance and social functioning. Objective scores obtained through the use of the VR program showed a pattern of learning in emotion perception, assertive behaviours and time spent in a conversation. Most of these gains were maintained at four-month follow-up., Limitations: The reported results are based on a small, uncontrolled pilot study. Although there was an independent rater for the self-reported and informant questionnaires, assessments were not blinded., Conclusions: The results showed that the intervention may be effective for improving social dysfunction. The use of the VR program contributed to the generalisation of new skills into the patient's everyday functioning., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: A significant number of individuals with brain injury demonstrate behavioral challenges that negatively affect their ability to live successfully in community settings. While there are a number of treatment approaches that have demonstrable effects in well controlled clinical settings, it is very difficult to implement these approaches in natural settings., Objectives: The goal of this study was to report the results of an investigation of the effects of a multicomponent behavioral intervention on the challenging behavior of an adolescent and young adult with growing behavioral concerns after acquired brain injury (TBI)., Methods: The participants were an 16 year old adolescent male and a 24 year old female, with escalating behavior problems after severe TBI. Multiple baseline designs were used to document the effects of an intervention package that integrated cognitive and executive function intervention to address severe challenging behaviors in natural settings. The following dependent variables were used to establish the effectiveness of the interventions: frequency and intensity of aggressive behaviors and participation in scheduled activities. The intervention included integrated components of positive behavior supports, cognitive supports and specific executive function scripts., Results: These single subject experiments demonstrated the effectiveness of a multicomponent intervention on the reduction of the frequency of problem behaviors and the increase of pro-social behaviors., Conclusion: These two successful interventions extended the findings of previously published data for the successful treatment of behavioral challenges using a flexible support-oriented intervention that combines behavioral, cognitive, and executive function components.

Objective: Social cognition is profoundly impaired in patients with schizophrenia. This study describes 'Mental-State Reasoning Training for Social Cognitive Impairment' (SoCog-MSRT), a 5-week program developed to improve social cognition in patients with schizophrenia. We aimed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements. METHOD The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder. Training comprised 10 twice-weekly sessions, for 5 weeks, with a pre- and post-training assessment., Results: There were significant improvements on: (a) a classic false-belief test of Theory of Mind (ToM); (b) inferring complex mental states from the eyes; and (c) a self-reported measure of social understanding. Some of these improvements were associated with baseline levels of working memory and premorbid Intelligence Quotient (IQ). CONCLUSIONS SoCog-MSRT can improve ToM abilities and social understanding, but individuals with poorer working memory and lower premorbid IQ may be less able to benefit from this type of training.

Objective: To report about existing evidence of effectiveness of social skills training for severely mentally ill adults., Methods: Systematic electronic and manual literature search for systematic reviews and randomized clinical trials (RCTs)., Results: Social skills training is a widely used intervention for people with severe mental illness. We identified four reviews and seven RCTs demonstrating the efficacy and effectiveness of social skills training. Results suggest that patients would benefit from trainings by improving social skills and social functioning. There are ambiguous results regarding other outcomes., Conclusions: People with severe mental illness should be provided with social skills training, if necessary, combined with cognitive remediation. Those techniques are required which actively support the generalization of positive achievements into patients' natural environments., (© Georg Thieme Verlag KG Stuttgart · New York.)

In some neuro-developmental disorders, the combined effect of intellectual disability and atypicalities of social cognition may put individuals at increased vulnerability in their social environment. The neuro-developmental disorders Williams syndrome, characterised by 'hypersociability', and autism spectrum disorders, characterised by 'social withdrawal', are at two extremes of atypical social functioning in humans. In this article, we use Williams syndrome and autism spectrum disorders as exemplars to demonstrate how atypicalities of social cognition may contribute to social vulnerability in these populations. The lives of individuals with both these disorders are marred by an increased risk of social isolation, bullying, unsteady relationships, employment difficulties and abuse. While different behavioural interventions have been tried to improve social functioning in these populations, there has been great variability in their success. Finally, we discuss different issues regarding social independence of these individuals; including employment, safety and decision making., (© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.)

Objective: Research to establish an evidence-base for the treatment of conduct problems and delinquency in adolescence is well established; however, an evidence-base for interventions with offenders who are diverted from the juvenile justice system has yet to be synthesized. The purpose of this study was to conduct a meta-analysis of experimental studies testing juvenile diversion programs and to examine the moderating effect of program type and implementation quality., Method: A literature search using PsycINFO, Web of Science, and the National Criminal Justice Reference Service data-bases and research institute websites yielded 28 eligible studies involving 57 experimental comparisons and 19,301 youths., Results: Recidivism was the most common outcome reported across all studies. Overall, the effect of diversion programs on recidivism was non-significant (k=45, OR=0.83, 95%CI=0.43-1.58). Of the five program types identified, including case management (k=18, OR=0.78), individual treatment (k=11, OR=0.83), family treatment (k=4, OR=0.57), youth court (k=6, OR=0.93), and restorative justice (k=6, OR=0.87), only family treatment led to a statistically significant reduction in recidivism. Restorative justice studies that were implemented with active involvement of researchers led to statistically significant reductions in recidivism (k=3, OR=0.69). Other outcomes, including frequency of offending, truancy, and psycho-social problems were reported infrequently and were not subjected to meta-analysis., Conclusions: High levels of heterogeneity characterize diversion research. Results of this study recommend against implementation of programs limited to case management and highlight the promise of family interventions and restorative justice., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Therapeutic strategies for improving social cognition in patients with schizophrenia have shown much promise in improving social functioning, as well as remediating core psychotic symptoms. However, the efficacy of previous interventions has often been limited by the ambiguity and inconsistency of the categorized subdomains of social cognition, including theory of mind, emotion processing, social perception and attributional bias. Recent research in social and cognitive neuroscience has revealed many new issues that could contribute to the development of more integrated approaches for improving social functioning. The application of such neuroscientific work to a therapeutic and diagnostic context is likely to encourage more effective transference of learned skills to real-world social functioning. This article seeks to provide a comprehensive review of previous social cognitive interventions for schizophrenia, highlight some crucial limitations of these and present the relevance of recent advances in neuroscientific research in possible future treatment strategies. It is emphasized that a more integrated and naturalistic approach for improving social functioning with greater sensitivity for neuroscientific findings related to the psychopathology of schizophrenia is warranted.

Three separate studies were conducted in school, residential and after-school care settings to test the effectiveness of a music therapy-based social skills intervention program on improving social competence in children and adolescents. A total of 45 children (n = 12; n = 13; n = 20) aged 6-17 years with social skills deficits participated in a group-based five session intervention program. The same curriculum, adapted to be age appropriate, was used at all 3 sites. Specific deficits within the social skills areas of peer relations and self-management skills were targeted. Active interventions like music performance, movement to music and improvisation were used. Cognitive-behavioral techniques like modeling, feedback, transfer training and problem solving were also incorporated. Data on social functioning were collected before, during, and after the music therapy intervention from participants, appropriate adult personnel and via behavioral observations. Results indicated that significant improvements in social functioning were found in (a) school participant pre and post self-ratings, (b) researcher pre and post ratings of school participants, (c) case manager's pre and post treatment ratings for the residential participants, (d) after-school care participants' pre and post self-ratings, and (e) behavioral observations at all three settings. Additional changes, although not significant, were noted in teacher ratings, residential participant self- and peer ratings, and after-school case manager ratings. Results from these studies suggest that the music therapy intervention was effective in improving social competence in children and adolescents with social deficits. More research is warranted to provide additional guidance about the use of music therapy interventions to improve social functioning.

Background: The quality of behaviour support plans (BSPs) can be an important influence on the quality of the support provided to people with disability who show challenging behaviours. The Behavior Support Plan Quality Evaluation Guide II (BSP-QE II) is one tool that may be useful in assessing the quality of behaviour support plans. It has previously been used to assess BSPs to support children in schools in the USA. In this preliminary study, we examined the utility of the BSP-QE II for assessing behaviour support plans designed for adults with an intellectual disability in community support services in Australia., Method: Experienced practitioners were surveyed concerning the relevance of BSP-QE II components to the evaluation of BSPs in Australia, and an audit was conducted of randomly selected BSPs submitted as a statutory requirement to the Office of the Senior Practitioner., Results: The BSP-QE II showed evidence of acceptable construct validity and interrater reliability. There was evidence of a need for substantial improvement in the quality of BSPs, consistent with previous findings conducted using other audit tools., Conclusions: The findings support the utility of the BSP-QE II, to inform and evaluate service planning in supporting adults with intellectual disability who show challenging behaviour.

With the rapidly aging population, it is expected that increases in cases of dementia will double over the next 20 years. Currently, there is no cure for diseases such as Alzheimer's disease or frontotemporal dementia (FTD) that cause progressive dementia, and only a few pharmacological interventions that slow the progression of the decline exist. Given that there is no cure available, a rehabilitation approach that emphasizes maintaining existing abilities and removing excess disability (as opposed to emphasizing cure or recovery) for as long as possible is warranted. The current paper proposes that nonpharmacological rehabilitation efforts need to target 5 broad areas/targets: memory enhancement, altering social contingencies and communication styles, improving self-care skills, the arrangement of physical environments to maintain and improve functioning, and increasing physical fitness/physical activity. The purpose of this paper is to review specific behaviorally oriented interventions that target these 5 areas and show promise for inclusion in comprehensive rehabilitation efforts for individuals with dementia., (Copyright © 2010. Published by Elsevier Ltd.)

Social functioning deficits are a prominent feature of many neurological and psychiatric conditions, and may include disruption in the acquisition or application of basic or complex social skills. Such disturbances are often resistant to treatment, and individuals with such conditions are often faced with lifelong difficulties in maintaining personal relationships, employment, and independent living. In recent years, a number of psychosocial treatments have been developed to address this growing problem. In this article, we review studies investigating the use of psychosocial training interventions in individuals with acquired brain injuries, which frequently require intervention for impairments in cognitive and social functioning. We then discuss limitations of these studies and highlight specific areas in which such treatments might be improved in the future.

We compared the efficacy of, and adolescents' preferences for, a Cognitive Behavioural (CBT) and Personal Development (PD) Anger Management (AM) group. The CBT group aimed to help adolescents develop skills to manage predominantly reactive aggression. The PD group aimed to enhance motivation to develop less aggressive identities with less use of proactive aggression. Eighteen adolescents were randomly allocated to a 10-session CBT or PD AM Group; seven additional adolescents formed a control group. They completed pre- and post-intervention questionnaires to assess anger expression and control, use of AM coping skills (also completed by carers) and self-image. Participants were also interviewed pre- and post-intervention; transcripts were subjected to Interpretive Phenomenological Analysis. Both treatment groups demonstrated significant improvements in anger coping and self-esteem, relative to the control group. Participants' age was significantly correlated with self-image and anger control outcomes in the CBT group. Qualitative analysis identified factors associated with improved outcomes, particularly regarding participants' age, motivation and readiness to change, engagement in the therapeutic process, group dynamics and emotional expressiveness. Our ability to interpret data clinically was enhanced by the use of a mixed quantitative-qualitative methodology. The results help us to better match interventions to clients.

Introduction: The psychosocial consequences of psychosis in the youth are educational negligence's, poor peer relations and difficulties in achieving life independency. MORS--the Stationary Model Centre of Sociopsychiatric Rehabilitation was created for overcoming these problems., Aim: To present the programme of rehabilitation and its effects in MORS., Method: The evaluation was performed in 18 of the 26 young persons being admitted to MORS in the years 2006-2008. Structured Questionnaires of past history for the staff and clients, the SOC-29 and KIDscreen -52 scales were used., Results: A significant number of young people from incomplete families, and/or families burdened with parental mental health problems was noticeable. The best effects were achieved in compensating for educational negligence's, and improving the social and life skills. The self estimation of health and life satisfaction was lower in the youth clients on discharge from MORS than in the general population., Conclusions: According to retrospective evaluation, the stationary programme of psychosocial rehabilitation in MORS seems to be effective in youths with psychotic disorders and difficulties in social functioning. Further development, and prospective evaluation of that programme would be valuable. Social support in local communities for the youth being discharged from MORS is needed.

Among young people with emotional and behavioral problems (EBP), mutual aid is likely to be valuable in their rehabilitation and deserving of social work support. The benefits of mutual aid stem from the possibility that it prolongs the effective contribution of social work service. Given its potential benefits, it is imperative to clarify the ways in which social work service maximizes these benefits. Such clarification is necessary both to verify untested theories about social work inputs to mutual aid and because the research literature on mutual aid among young people is particularly lacking. Based on data from three focus groups involving social workers in Hong Kong, this study seeks to demonstrate the relevance of theoretically based group work strategies in the mutual aid and rehabilitation of EBP youth. These strategies include identifying commonalities and setting prioritiese, balancing support with demand, optimizing input between social workers and members, and connecting members with relevant others in the community. The research and service implications of the findings of this study for promoting efficient social work input that contributes to the long-term development of young people are discussed.

Background: Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach., Method: The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement., Results: All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1-year follow-up., Conclusions: Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.

This study consists of a comparative analysis of patterns of de-escalation between ages 17-18 and 32, based on data from two well-known prospective longitudinal studies, the Cambridge Study in Delinquent Development (a study of 411 working-class males in London) and the Montreal Two Samples Longitudinal Study (a sample of 470 adjudicated French-Canadian males). Analyses focus on within-individual change, with individuals serving as their own controls. In this regard, the magnitude of measured change is relative to the past degree of involvement in offending. These results are contrasted with predictors of between-individual differences in offending behavior at age 32. We investigate the respective roles of cognitive predispositions and social bonds in the prediction of patterns of de-escalation, and assess whether it is possible to make relatively long-term predictions (over a 15-year period) about offending in adulthood. Findings suggest that traditional measures of social bonds and cognitive predispositions measured at age 17-18 are generally weak predictors of de-escalation up to age 32. However, these measures are stronger predictors of between-individual differences in offending gravity. These findings highlight the difficulties in making accurate long-term predictions about changes in individual offending patterns early in the criminal career.

Background: People with profound and multiple disabilities often display aberrant behaviours (such as stereotypical movements) which can inhibit learning and lead to social stigmatisation. This study was designed to help a man with multiple disabilities increase his object-contact responses and reduce hand stereotypy (in this case, hand/wrist rotation)., Method: An A-B-A-B design with a 3-month post-intervention check was employed. At baseline, a combination of microswitches (or microswitch cluster) was used to monitor the man's object-contact responses and hand stereotypy. During the intervention phases and post-intervention check, the microswitch cluster was combined with preferred stimuli for object-contact responses occurring without hand stereotypy. The stimulation lasted for 8 seconds if the man remained free from hand stereotypy for that time, but was interrupted if the stereotypy appeared., Results: The intervention showed an increase in object-contact responses occurring without hand stereotypy and a reduction in session time with hand stereotypy. These data were maintained at the 3-month post-intervention check., Conclusion: Replication of these findings with other individuals would confirm the utility of this type of intervention for increasing constructive responding and reducing stereotyped behaviours.

Background: Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary., Method: In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared., Results: During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1-34), and 12% in auto-aggressive incidents (range per client 1-92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women., Conclusions: Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.

Aims: The health hazards and prevalence of ecstasy use have been documented in two decades of research, but no review reporting on potentially modifiable antecedents of use is available. The aim of this study was to integrate systematically research identifying cognitive correlates of ecstasy use. Such research has the potential to identify targets for evidence-based interventions designed to discourage use., Methods: The databases PsycINFO and MedLine were searched, inclusion criteria applied to resulting hits, and descendency and ancestry approaches applied to the selected publications. Reported associations between cognitive determinants, including intention to use and ecstasy use measures, were synthesized by calculating a weighted mean effect size, r., Results: The pattern of associations lent support both to the theory of planned behaviour (TPB) and the expectancy approach as descriptions of potentially useful determinants. Attitudes were associated most strongly with intention and use, followed by subjective norm and perceived behavioural control., Conclusions: Consideration of the strength of associations and the potential modifiability of identified cognitions suggests that evidence-based interventions to discourage ecstasy use should target negative expectancies, perceived behavioural control and anticipated regret, and consider tailoring perceived behavioural control elements.

Home visits are one of the intervention and assistance methods anticipated to be useful in cases of social withdrawal. This study aims at investigating the current status of home visits that are carried out in the regional mental health and child welfare sectors, targeting socially withdrawn adolescents, and at examining the efficacy of this method. We conducted a survey using questionnaires targeting 59 institutions, such as public health centers, health and welfare offices, and child guidance centers, and found that home visits were carried out by public health nurses and child welfare personnel in about 20% of the adolescent social withdrawal cases. Answers to the question sheets were obtained for 54 cases, and investigation revealed that some form of improvement was seen as a result of these visits in 22 cases, or 40.7%. Typical answers included: "the visit encouraged the adolescent to go to a medical institution and/or a consultation agency for examination or consultation," and the "incidence of domestic violence by the adolescent declined." The survey also revealed that 19 of the social withdrawal cases, or 35.2%, inflicted acts of violence on family members; however, 8 cases, or 42.1% showed the improvement of violence through home visits.

Primary Objective: To describe the characteristics and determinants of aggressive behaviour observed within a neurobehavioural unit., Research Design: Statistical analysis of a database of routinely administered clinical measures, including the Overt Aggression Scale-Modified for Neurorehabilitation., Methods and Procedures: Records of aggressive behaviour shown by 108 patients over 14 days were studied. Patient characteristics were also captured using 23 items from the Rehabilitation Institute of Chicago-Functional Assessment Scale. Four factors were identified: 'communication', 'cognition/function', 'neurobehavioural disability' and 'mood & self-esteem'. Relationships between patient characteristics, external factors and their interactions with aggression were examined., Main Outcomes and Results: Many (5548) episodes of aggression were recorded. Whilst most comprised verbal aggression, 729 physical assaults were made on others. Aggressive behaviour typically followed staff prompting or no obvious antecedent. Medical intervention was rare, most aggression was managed by staff not reinforcing this behaviour. Over 80% of physical assaults were made by people rated as having severe symptoms of neurobehavioural disability and poor communication., Conclusions: Neurobehavioural units require sufficient staff resources to engage patients in purposeful activities as these were associated with the least severe aggression. Despite increased OAS-MNR usage, a standardized methodology for investigating aggression is required to ensure compatibility between datasets.

Objective: The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming., Method: The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah's goals of going to preschool and becoming a friend., Results: Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person-task-social context, pushing participation, and engaging in narrative micronegotiations., Conclusion: Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.

This column describes the development of a treatment, the Social Cognition and Interaction Training (SCIT) program, a group-based intervention delivered weekly over a six-month period, with the purpose of improving both social cognition and social functioning among persons with schizophrenia spectrum disorders. SCIT comprises three phases: emotion training, figuring out situations, and integration. Initial pilot testing of 17 inpatients showed that SCIT was associated with improved emotion perception, improved theory of mind, and a reduced tendency to attribute hostile intent to others, with effect sizes being in the medium-large range. Although research is still in the early phases, SCIT is a potential best practice.

Objective: To assess the social disability of people with different psychiatric disorders., Methods: Cross-site survey in five psychiatric hospitals (Dresden, Wrocław, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n=969) and 3 months after discharge (n=753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability., Results: During acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points., Conclusion: Severity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.

This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot-movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3-month post-intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post-intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.

Objective: Despite the recognition of the need for group-based training programmes for children and adolescents with autistic disorders, there are only very few specific German-speaking training programmes available. Since 2003, a structured group training programme on social skills for children and adolescents with high-functioning autism or Asperger syndrome has been developed and conducted at our department. The training programme focuses on the main deficits of those disorders. Thus, the primary goal is to improve communication and interaction skills., Method: Participants are children and adolescents without significant cognitive and language delays. Principles of intervention include structured formats, combination of theoretical and practical elements, predictable rules, consideration of individual difficulties, and sequential and progressive learning. Techniques range from structured games, the training of affect recognition, group activities, role play, team discussions, and feedback to homework using a newly designed manual on our group-based social skill training programme and curriculum. Generally, three groups of 5-7 participants each and of different age range (children, adolescents) meet weekly/biweekly for 1-1.5 hours (excluding the holidays). Two trainers--who change during the programme--carry out each of the sessions. Trainers meet regularly with the parents to discuss experiences and to provide details of the programme., Results: Acceptance by and satisfaction with the programme are high among participants, as is the mutual recognition of and tolerance of their respective problems. Both feedback from parents and trainers' clinical impressions indicate distinct improvement of verbalization and contact abilities. Participants seem to benefit particularly from role play., Conclusions: Qualtitative measures (impressions of the participants, their parents and their trainers with regard to change in behaviour skills) suggest mounting interaction, communication, and problem-solving skills during the group treatment. An ongoing pilot evaluation also includes measurements of effects in everyday settings. Depending on the results, the training subsequently could be conducted and evaluated in groups with both pervasive developmental, as well as other psychiatric disorders.

The aim of this study was to evaluate whether involvement in a 16 week exercise programme improved goal attainment in areas of behaviour, access to community-based experiences, health and physical competence. Participants were women with severe intellectual disability and associated challenging behaviour (setting A,N = 14) and male/female service users with profound physical and intellectual disabilities (setting B,N = 8). The exercise programme included active and passive exercise, walking, swimming, hydrotherapy, team games and rebound therapy. Significant gains in aggregated goal attainment were demonstrated by week 16. The reliability and validity of our goal attainment procedures were demonstrated with inter-rater reliabilities exceeding 80 percent. Changes in goal attainment were concurrent with global clinical impression scores in a series of single case studies. Continuing care settings should dedicate care staff to provide routinized, continuing exercise programmes.

Background: Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre., Methods: This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model., Results: Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group., Conclusions: Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.

Background: The purpose of this paper is to describe long-term outcomes for patients discharged over a 12-year period from a medium secure service for people with intellectual disabilities (ID)., Methods: A cohort study using case-notes analysis and a structured interview of current key informants., Results: Eleven per cent of the sample was reconvicted. Fifty-eight per cent of the sample showed offending-like behaviour that did not lead to police contact. Twenty-eight per cent of the sample was currently detained in hospital under the Mental Health Act. The presence of a personality disorder, a history of theft or burglary, and young age increased the risk of reconviction. Contact with the police was less likely in those with schizophrenia. Re-admission to hospital was associated with the presence of offending-like behaviours, rather than any specific diagnosis., Conclusion: In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced. Declaration of interests Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.