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Background: The main objective was to replicate data on the external validity of the Sluggish Cognitive Tempo (SCT) dimension, versus ADHD Inattention (IN), with the Spanish version of the Child and Adolescent Behavior Inventory (CABI) SCT subscale [Cuestionario sobre el Comportamiento de Niños] (Burns et al., 2015). Method: 273 mothers and 255 fathers evaluated their 9 to13 year old children on SCT, IN and other CABI internalizing, externalizing, academic impairment and social interaction measures. Results: As hypothesized, the relationship between SCT and externalizing measures, in contrast to IN, was practically nonexistent, whereas both measures were related to internalizing and social interaction measures. Thus, the unique predictive capacity of SCT and IN was significant and similar on internalizing measures, except in the case of shyness, where SCT was better, while IN was better on externalizing measures. Conclusions: The data largely replicated previous results: SCT, despite its relationship with IN, is capable of predicting a significant proportion of anxiety, depression, and excessive shyness problems and, unlike IN, functions as a protective measure for externalizing problems. [ABSTRACT FROM AUTHOR]

Background: Psychometric properties and initial normative information are provided for the sluggish cognitive tempo, attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder, callousunemotional behavior (limited prosocial emotions specifier), anxiety, depression, social impairment, and academic impairment scales of the Spanish Child and Adolescent Behavior Inventory. Method: Mothers, fathers, and teachers of 2,142 third to sixth grade Spanish children (49.49% girls; ages 8-13) from randomly selected schools on the Balearic Islands completed the Child and Adolescent Behavior Inventory. Results: Scores from the scales demonstrated reliability (internal consistency and inter-rater), structural validity, and convergent/discriminant validity with attention-deficit/hyperactivity disorder and learning disorder diagnoses for boys and girls separately for each source. Normative information (T-scores) is provided for the nine scales separately for boys and girls, with test information functions supporting use of the symptom scales for screening purposes. Conclusions: Although more comprehensive Spanish norms are still needed, the initial normative information on the scales should be useful to inform the clinical care of individual Spanish children, with the positive psychometric properties of the scores also supporting the use of the scale for research. Copies of the Spanish Child and Adolescent Behavior Inventory and norms are available for free to clinicians and researchers. [ABSTRACT FROM AUTHOR]

Girls with attention-deficit/hyperactivity disorder (ADHD) are at high risk for peer difficulties that often persist into adolescence and adulthood and portend risk for additional difficulties, such as depression, anxiety, and borderline personality disorder. However, very little research has examined interventions that address the widespread peer difficulties of girls with ADHD. This paper describes two open trials of behavior therapy aimed at addressing their social-emotional difficulties. The first trial includes 33 preadolescent girls (ages 7–11) with ADHD enrolled in an eight-week treatment and the second trial includes 22 adolescent girls (ages 12–16) with ADHD enrolled in a 12-week treatment. Measures of treatment feasibility and acceptability and measures of social functioning and psychopathology were collected in both trials. High levels of treatment feasibility and acceptability were reported in both the preadolescent and adolescent trial. In addition, improvements were reported in areas of social functioning and reductions in psychopathology, although the magnitude and specific areas of improvement differed somewhat in the preadolescent versus adolescent group. These preliminary findings provide a first step toward addressing the widespread social-emotional difficulties of girls with ADHD and offer insight into continuing efforts to address their treatment needs. [ABSTRACT FROM AUTHOR]

Objective/Background: The purpose of the study was to pilot a five-week insomnia treatment in adolescents with major depressive disorder (MDD) and insomnia. This was an open-label trial of a modified-group cognitive behavioral therapy for insomnia (CBTI). Participants: Adolescents with MDD (n = 16; mean age = 17.3 +/- 1.7), characterized by the Children's Depression Rating Scale-Revised T-score ≥ 55 and insomnia, characterized by > 30 min to fall or return to sleep and an Insomnia Severity Index (ISI) score of ≥ 7 participated. Methods: Sleep diaries, actigraphy, weekly ISI, Quick Inventory of Depressive Symptomatology (QIDS), and Multidimensional Fatigue Inventory (MFI) were completed. Results: Paired t-tests comparing pre- and posttreatment revealed a decrease in sleep onset latency from 41 min +/- 14 min to 18 min +/- 8.9 min (t = 5.9, p =.004). Linear mixed modeling across sessions revealed that ISI (B = 11.0, SE = 0.94, p <.001), QIDS (B = 11.3, SE = 0.96, p <.001), and MFI (B = 30.0, SE = 4.4, p <.001) improved across treatment. Daily sleep diaries showed decreased wake during the night (B = 22.8, SE = 7.19, p =.008), increased sleep time (B = 382.4, SE = 71.89, p <.001), and increased quality of sleep (B = 3.7, SE = 0.37, p <.001). When asked whether group members would recommend this group, 27% responded "yes" and 73% responded "definitely yes." Conclusions: Additional controlled studies utilizing sleep-focused therapy in depressed adolescents with insomnia are warranted. [ABSTRACT FROM AUTHOR]

Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings. Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems. [ABSTRACT FROM AUTHOR]

The present study evaluates the implementation of the Coping Power Program (CPP)-Child Component in a group of patients with attention deficit/hyperactivity disorder (ADHD), and explores the effects of this treatment on changes in the primary and associated symptoms of ADHD. A clinical sample of 50 children and preadolescents (8-13 years) with ADHD was involved. The clinical sample was split into a treatment group (TG; N = 26), which was included in the child training program (CPP), and a control group (CG; N = 24), which was placed on a waiting list. The Clinical Global Impression-Severity (CGI-S) and the Child Behavior Checklist 6-18 (CBCL 6-18) were assessed at baseline and at the end of treatment. The outcomes were assessed as a CBCL-subscale response rate and a CGI-S shift. Our results showed a significant improvement in children’s global functioning and in emotional and behavioral symptoms. The children in the TG were more likely to shift from a more severe functional impairment class to a less severe one (69.2% of TG vs. 20.8% of CG). Further, the CGI-S scores diminished significantly in the TG (p < 0.01). There were significant differences in the changes in Social Problems (p < 0.05), Attention Problems (p < 0.05) and Rule-Breaking Behavior Scales (p < 0.05). CPP seemed to be effective in children and adolescents with ADHD without comorbidity for ODD or CD. Our study revealed an improved outcome, not only in the core symptoms of ADHD, but also in global functioning and social adjustment. Possible improvements to the present formulation of CPP-C are discussed. [ABSTRACT FROM AUTHOR]

Pets are part of many adolescent’s lives. Objectives: To identify in a large national representative sample of Portuguese adolescents (HSBC study), the percentage of adolescents that have pets, what kind of feelings pets provide, differences by gender and age (through school grades) and to verify whether adolescent health, well-being, life satisfaction and psychological symptoms are associated with having a pet. Methods: The 2014 study provided national data of 6026 Portuguese adolescents (52.3% of which were girls), whose mean age was 13.8 years, randomly selected from those attending 6th, 8th and 10th grades. Measures included asking the participant if he/she had pets, which pet was, and the relationship they had with the pet, ISS, perception of well-being, life satisfaction and psychological symptoms. Results: The large majority of Portuguese adolescents had a pet. Adolescents who referred having a pet reported more frequently having dogs and cats. As for positive feelings related to pets, results showed that pets give them feelings of happiness, companionship, nurturing, tranquility, security and responsibility always/almost always, especially in girls and younger boys. The results also showed that having a dog was associated with a higher socio-economic status, better perception of well-being, more life satisfaction and less psychological symptoms. Conclusion: Since research shows that young people who have pets report higher rates of well-being/health perception, that information should be used to conduct more studies and change policies in ways that benefit adults and children. [ABSTRACT FROM AUTHOR]

Revealing how health-related lifestyle behaviors are associated with competences during adolescence can contribute to understanding the complexity of factors that intervene in adolescents’ health. The objectives of this study were to explore the clustering of different lifestyle behaviors and their connection to personal and community competence. Participants were 795 adolescents who were taking part in the initial assessment of a Spanish community-based intervention program. They were asked to complete four self-report measures: the Lifestyle Questionnaire, the Self-Concept and Social Realization Questionnaire, the Coping Scale for Children and Youth Questionnaire, and the Perceived Community Support Questionnaire. Cluster analysis was then used to discover different patterns of lifestyle behaviors and associate them with sociodemographic and competence factors. The cluster analysis revealed three groups of adolescents: a first group that presented all-round healthy habits, a second group with abusive screen use and a third group with unhealthy habits related to going out at night. These clusters were modulated by age, student status, psychosocial risk status and mothers’ level of education. Further analysis showed higher levels of Self-worth, Task-oriented strategy, Empathy and Community participation in the Healthy group compared to those in the Unhealthy group, whereas the Screen-user group had more Behavioral avoidance than the Healthy group and less Community integration than both of the other groups. The identification of personal and community competences as health-promoting factors associated with adolescents’ lifestyles may help professionals to prioritize certain strengths for best results in intervention programs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the neural correlates of cognitive-behavioral therapy (CBT) for externalizing behavior problems in perpetrators of school bullying using assessments of brain activity and behavior. Twenty-five adolescent bullies participated in an 8-session intervention. Prior to and after participation, 24 adolescents were evaluated using the Child Behavior Checklist (CBCL) and 23 completed resting-state functional magnetic resonance imaging. Changes in the fractional amplitude of low-frequency fluctuations (fALFF) and scores on the CBCL were analyzed. We also compared the identified changes into 2 groups (low and high delinquency) differentiated by a cutoff of 65 points on the delinquency subscale of the CBCL. Following the intervention, participants exhibited improvement in the subscores of the CBCL and decreases in the fALFF of the inferior parietal lobule, lingual, interior frontal and middle occipital gyrus. A positive correlation was observed between changes in the CBCL externalizing behavior scores and fALFF of the inferior frontal gyrus. The high delinquency group showed a greater decrease in delinquency and externalizing CBCL subscores across time than did the low delinquency group. The high delinquency group had more areas that showed change in fALFF post-intervention than did the low delinquency group. A positive correlation was observed between changes in the CBCL delinquency scores and fALFF of the precentral gyrus in the high delinquency group. The results indicate that this CBT for externalizing behavior problems in bullies had more positive effects on delinquent behavior in adolescents with high levels of delinquency, and these changes were associated with functional changes in brain activity. Trial registration: ClinicalTrials.gov identifier: NCT02670876 [ABSTRACT FROM AUTHOR]

This study evaluated dialectical behavior therapy for adolescents (DBT-A) vs. treatment as usual within a 6-week partial hospitalization program. The 103 adolescent participants (mean age = 15.27 years) were predominantly girls ( n = 63, 61%) with a variety of primary mental health diagnoses. Results indicated that DBT-A was superior for decreasing symptoms of depression and interpersonal sensitivity, but no statistically significant difference was detected for anxiety or hostility. Implications for treating youth with transdiagnostic identities are discussed. [ABSTRACT FROM AUTHOR]

Background: There are several newer technologies in this Era; one of such is Mobile Phones. The mobile phone has many attributes and characteristics that make it especially attractive to adolescents. Research has shown excessive use of mobile phones leads to addiction like behavior and various adverse effects. Aim: This study was designed to study the pattern of mobile phone usage and to evaluate the prevalence of mobile phone dependence among school going adolescents. Methods: A cross-sectional study was conducted among school going adolescent students, 253 adolescents participated in the study. Data collected by using a questionnaire to obtain information on mobile phone usage pattern and mobile phone dependency. Statistical analysis is done using SPSS software, relevant statistical tests Chi Square and Fischer Exact test were applied. Results: Mean age of the participants is 14.65yrs. Majority of the participants possessed a smart phone 205(81%). The average time spent on mobile phones per day is 101 minutes with the mean duration of usage in years 3.26yrs Prevalence of mobile phone dependency was found to be 170(67.2%).Nearly half 125(49%) of the students reported false perception of mobile phone ringing and 88(34.8%) of them reported they slept late due to mobile phone usage. Conclusion: Mobile Phone dependency is a new emerging public health concern, due to the ill effects it predisposes on the younger generation. But, mobile phones can act as a boon also, when used effectively; hence adolescents need right motivation for the better usage of mobile phones. [ABSTRACT FROM AUTHOR]

This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50 % male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74 %), African American (11 %), multiracial (11 %), and other (4 %). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at 6-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures. [ABSTRACT FROM AUTHOR]

This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates. [ABSTRACT FROM AUTHOR]

The therapeutic relationship in Cognitive Behavioural Therapy (CBT) has been argued to play an essential role in positive outcomes in therapy. However, it is described as necessary and yet, secondary to technique, often receiving little attention in the training of CBT therapists. This case study explores a trainee psychologist's experience of finding difficulty in feeling authentic and the application of CBT techniques with her client. This difficulty informed the research question; what is the value of the therapeutic relationship in CBT? A hermeneutic approach with a strong emphasis on phenomenology, is used to explore the therapeutic process and the therapeutic relationship that developed between therapist and client. Qualitative descriptions of 11 sessions are divided into themes, these are discussed in relation to what happened in therapy, and are then discussed further regarding discovery and process into the therapeutic relationship. Conclusions from this case study could possibly reveal the value of the therapeutic relationship when working from a CBT approach, and how it seemed to enable the client to achieve her goal in therapy. [ABSTRACT FROM AUTHOR]

Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co-occur among youth with obsessive-compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha-2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14-year-old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20-session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic-related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD. [ABSTRACT FROM AUTHOR]

In the present study, we evaluated a model of relations among contextual factors (family, school, and peer group), personal identity (i.e., coherence and confusion), and problem behavior among Iranian adolescents. The sample consisted of 765 Iranian adolescents and 615 primary caregivers. Results indicated that family functioning (adolescent report) was related to adolescent problem behavior (a) directly and (b) indirectly through identity confusion. Peer support on the other hand was solely indirectly related to adolescent problem behavior through identity confusion. School functioning was also significantly and negatively related to adolescent problem behavior. The present findings suggest that identity and contextual factors play important roles in steering Iranian adolescents toward or away from behavior problems. Implications for further research are discussed. [ABSTRACT FROM PUBLISHER]

Objective: This study evaluates a parent-teen skills-based therapy for attention deficit/hyperactivity disorder (ADHD) blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens' Autonomy Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning, or OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions. Method: The current randomized trial (N = 128) evaluates efficacy at posttreatment and 6-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU). Results: Primary findings were that (1) STAND was delivered in an Mi-adherent fashion and most families fully engaged in treatment (85% completed); (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording; and (3) 6 months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained. Conclusion: Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate changes in school functioning, including motivation, intentions to quit school and social relations in school, following an early group based CBT intervention implemented for depressed adolescents. The “Adolescent Coping with Depression Course” (ACDC) is such an early group intervention. The primary target group in the present study was 16–20 years old adolescents with subclinical or mild-to-moderate depression. The research design implemented was a pre-post design. Results indicated a strong reduction in depressive symptoms among study participants according to Cohen's criteria, a small to medium improvement in perceived social relations in school, but no change in school motivation and intentions to quit school. [ABSTRACT FROM PUBLISHER]

The construction of the self is a central process in adolescents’ life, and an adequate parent–adolescent relationship is an important factor in promoting this development. In order to better understand this development of self within the family context this study examined the ways in which parent–adolescent boundary dissolution, adolescent true-self behavior and motives for false-self behavior are manifested in adolescents’ self-representations. Differences in adolescents’ self-figure drawings as a function of their true-self behavior, motives for false-self behavior, and their experience of various types of boundary dissolution with their parents in a sample of Israeli early to mid-adolescents ( N = 333, Mean age = 14.00, SD = .69) were examined. Drawings were coded using the DAP-SPED coding system as well as a more global approach. The findings indicated positive correlations between psychological control with mother and father, triangulation with the father and the number of deviant indicators in self-drawings. Adolescents who drew detached and bizarre self-drawings showed higher levels of motives for false-self behavior with parents. Adolescents who drew bizarre self-drawings experienced higher levels of triangulation and psychological control with mothers and higher levels of triangulation with fathers. The implications for theory and clinical interventions are discussed. [ABSTRACT FROM AUTHOR]

Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way to promote implementers' treatment integrity is Implementation Planning, a logistical planning and barrier reduction strategy that is supported by emerging school-based research. The current study extended the research on Implementation Planning and evaluated the effectiveness of the strategy with parents implementing a behavioral intervention at home within a Conjoint Behavioral Consultation model. The behavioral intervention aimed to increase compliance and decrease aggression for two children with ASD at home. Initially, parents struggled to deliver the intervention consistently; however, after Implementation Planning, parents' treatment integrity increased and, subsequently, child outcomes improved. Implications for future research and consultation are presented. [ABSTRACT FROM PUBLISHER]

Therapists are often frustrated when they work with adolescents who do not talk about their experience. This article presents a way of working with these teens. The underlying theory assumes that most teenagers (including those who are often silent in therapy) are capable of being mutually engaged with someone else. This capability is seen as a self-state that can be dissociated by anxiety and replaced with another self-state that is withdrawn and unengaged. Three clinical vignettes describe silent teenagers with whom the therapist eventually can activate self-states that allow for engagement; in these cases, through mutual help, fair play, projective identification, controlling or sadomasochistic connections. Other self-states are withdrawn and silent. For a long initial period, the family and developmental histories that create these self-states are usually more unknown than known, and the shifts in self-states are dealt with in the therapist-patient interaction more than in psychodynamic interpretations, explanations or reconstructions of family or developmental experience. [ABSTRACT FROM AUTHOR]

Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases ( n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT. [ABSTRACT FROM AUTHOR]

Background In children, severe, life-threatening traumatic injuries of the thoracic aorta can be seen after motor vehicle collisions (MVCs) resulting in a sudden deceleration. Concurrent injuries in the thorax and abdomen can make treatment prioritization difficult and require early recognition and prompt intervention. With the increased utilization of minimally invasive endovascular approaches to traumatic aortic (TA) injuries, patients are often spared the increased surgical morbidity (spinal cord ischemia and renal insults) that can be seen with an open technique. The aim of this study was to evaluate a single American College of Surgeons level 1 pediatric trauma center's 22-y experience with TA injuries in children. Methods After the Institutional Review Board approval, a 22-y (January 1990-April 2013) retrospective review of all pediatric trauma patients admitted with TA injuries was performed. Patient demographics including age, injury detail, treatment, and outcomes were recorded for analysis. Results 17 children (<21-y old) were identified with ages ranging from 13-20 y old. The most common mechanism of injury was MVC with all 17 children sustaining TA injuries. The traumatic injuries included aortic transection (9), intimal flap (5), pseudoaneurysm (2), and contained thoracic rupture (1). All children were managed operatively with those before 2008 using an open technique. The endovascular approach was used in 7/17 (41%) cases with the median length of hospitalization 12 d versus 22.5 d using the open approach (P < 0.05). No child required conversion from an endovascular to an open technique for treatment of the aortic injury. There were no operative deaths, no procedure-related paraplegia and all children were discharged home from the hospital. Two children had mild mental deficits as a result of head trauma. Conclusions TA injuries are an uncommon injury in children and can result from MVCs or other sudden deceleration mechanisms. Surgical intervention is required in most of the cases and can be performed safely and effectively with low morbidity using an endovascular approach, which is the evolving approach of choice for thoracic aortic injuries. Lengthy follow-up care is recommended in children treated with an endovascular device to monitor for endoleaks and device complications. [ABSTRACT FROM AUTHOR]

Clinically elevated anxiety is a common, impairing feature of autism spectrum disorders (ASD). A modular CBT program designed for preteens with ASD, Behavioral Interventions for Anxiety in Children with Autism (BIACA; Wood et al., 2009) was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety. Thirty-three adolescents (11–15 years old) were randomly assigned to 16 sessions of CBT or an equivalent waitlist period. The CBT model emphasized exposure, challenging irrational beliefs, and behavioral supports provided by caregivers, as well as numerous ASD-specific treatment elements. Independent evaluators, parents, and adolescents rated symptom severity at baseline and posttreatment/postwaitlist. In intent-to-treat analyses, the CBT group outperformed the waitlist group on independent evaluators’ ratings of anxiety severity on the Pediatric Anxiety Rating Scale (PARS) and 79% of the CBT group met Clinical Global Impressions–Improvement scale criteria for positive treatment response at posttreatment, as compared to only 28.6% of the waitlist group. Group differences were not found for diagnostic remission or questionnaire measures of anxiety. However, parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity. The CBT manual under investigation, enhanced for early adolescents with ASD, yielded meaningful treatment effects on the primary outcome measure (PARS), although additional developmental modifications to the manual are likely warranted. Future studies examining this protocol relative to an active control are needed. [ABSTRACT FROM AUTHOR]

The objective of this paper was to present an original project titled 'Sports 2014 - Multifactorial Environmental Model', designed to reinforce positive behavior and create a sense of community among urban youth. It evolved together with the subsequent phases of an urban health promotion program that began in 1994 in Wrocław, Poland. However, the basis of this model was in creating a health promotion initiative that included elements of the Mandala model of health, an ecological model, and the 'Your Neighborhood's Coach' health promotion and at-risk prevention program, begun in 2003 by the Sports Department of the City of Wrocław and continued to this day. This type of initiative was designed to include measures typical of a prevention program while also promoting an active lifestyle through constructive leisure activities. Its guiding philosophy was the 'get involved' rather than 'dissuade from' approach, which has found popularity in programs of a similar nature across the world. The presented 'Multifactorial Environmental Model' is addressed to active counselors, coaches, psychologists, health promotion figureheads, and policymakers whose goal is to reduce negative and anti-social behavior in today's youth. It should also find value among the pedagogical community of physical education institutions, as the presented work may serve as a source of experience when deciding on any significant changes in the education of future physical education teachers, coaches, and recreation instructors working with adolescents. [ABSTRACT FROM AUTHOR]

Objective Joint use policies (JUP) encourage shared facility use, usually between schools and a city or private organization, for both physical activity-related and non-physical activity-related programs. Little is known about JUP's impact on physical activity (PA). This study examined whether more specific JUPs were associated with increased PA and decreased sedentary behavior (SB) in adolescents. Methods Data on PA, sports participation, and SB were taken from annual cross-sectional nationally representative samples of 51,269 8th, 10th and 12th grade public school students nested in 461 school districts in the US from 2009-2011. JUP measures were constructed using information obtained from corresponding school district JU policies. Multivariable analyses were conducted, controlling for individual demographic and socioeconomic characteristics and clustering at the district level. Results Results showed small associations between more specific JUPs and increased PA (IRR 1.01, 95% CI: 1.00, 1.02). Closer examination of specific JUP provisions indicates that specifying what times facilities are available for use was associated with vigorous exercise and prioritizing school or affiliated organizations' use and which spaces were available for use were associated with vigorous exercise and more frequent PA participation, which includes participation in sports or athletics. No associations were found between more specific JUPs and SB. Conclusions JUPS may have small influences on adolescent physical activity behavior. Future longitudinal studies should be conducted to examine the impact of JUPs in conjunction with other physical activity-related policies and environmental changes to determine what impact they have on overall adolescent physical activity and sedentary behavior. [ABSTRACT FROM AUTHOR]

The article discusses the identification, diagnosis and management of attention-deficit hyperactivity disorder (ADHD) among children and adolescents. Topics include the clinical problem of ADHD which affects daily basic functions and social relationships of patients, its classification, pathogenesis, and risk factors, and diagnostic strategies. Also included are treatment techniques including behavioral therapy, and medications and its concerns, guidelines, and recommendations.

Depression rates rise dramatically from the early to late adolescence. Especially young adolescent girls with elevated depressive symptoms are at high risk for developing a depression during adolescence or adulthood. Therefore, the prevention of depression is important especially in this high-risk group. The aim of the present study was to examine the effectiveness of the Cognitive Behavioral Therapy (CBT) component of the depression prevention program 'Op Volle Kracht' (OVK) among Dutch adolescent girls with elevated depressive symptoms. In total, 102 adolescent girls (11-15 years) in the first and second year of secondary school participated in this study. The girls in the experimental group ( n = 50) followed the eight CBT-lessons of OVK and reported depressive symptoms 1 week prior to the start of the lessons, after every lesson, at one-month and 6-months follow-up. The girls in the control group ( n = 52) exclusively reported depressive symptoms at the same time points. Latent Growth Curve Modeling showed that the decrease in depressive symptoms was significantly larger for girls in the experimental group compared to the girls in the control group. Furthermore, it was found that at 6-months follow-up, the girls in the experimental group had significantly lower levels of depressive symptoms compared to the girls in the control group. These findings indicate that the CBT-component of OVK effectively reduces depressive symptoms in short term and possibly prevents the development of a clinical depression. [ABSTRACT FROM AUTHOR]

Background: Very few studies have investigated the effects of individual disorder-specific treatment of social phobia (SP) in adolescents. The objective of this study was to compare the effects of individual cognitive therapy for SP, group cognitive behavioural therapy (CBTG) and attentional placebo (AP) among adolescents with a primary diagnosis of SP. Methods: A randomized controlled design was used, and a total of 279 adolescents were assessed. Fifty-seven adolescents, between 13 and 16 years old, were allocated to individual cognitive therapy, CBTG or AP. The participants were assessed before treatment, at the end of treatment and at a 12-month follow-up using both self-report and a semi-structured interview. Results: The individual cognitive therapy showed significant reductions in symptoms, impairment and diagnostic criteria both at the end of treatment and at the 12-month follow-up. Compared with CBTG and AP, the individual cognitive therapy group demonstrated significantly greater effects on both symptom reduction and impairment. There were no significant differences between CBTG and AP. Conclusions: In a direct comparison between the most commonly used treatments for adolescent SP, we found that individual therapy was the most effective, yielding better effects than both CBTG and AP. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]