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Author(s): Deborah Allen [sup.1] , Chad Abresch [sup.2] Author Affiliations: (Aff1) 0000 0004 0428 8718, grid.416097.d, Health Promotion, Los Angeles County Department of Public Health, , 1000 S. Fremont Ave. [...]

Objective: this activity is to help children who have experienced grief and loss to deal with their roller-coaster feelings by using toy musical instruments to produce sounds that act as [...]

We examined the association of callous-unemotional (C/U) traits with the rates of seclusion and restraint among a sample of child psychiatric inpatients (N = 101). Analyses focused on the incremental value of C/U traits as a predictor over and above the influence of other risk factors for physically restrictive treatment measures found in previous research, including gender, age, verbal intelligence, ethnicity, the diagnosis of a conduct disorder or an oppositional defiant disorder, maltreatment history, and the other dimensions of psychopathy (i.e., narcissism and impulsivity). Results of hierarchical multiple regressions indicated that younger age and C/U traits predicted seclusion rates, whereas only C/U traits predicted restraint rates. The discussion of these findings focuses on the necessity of developing effective intervention programs for inpatient children with prominent C/U traits, to help forestall the physically dangerous behavior that necessitates a seclusion or restraint. Keywords Seclusion * Restraint * Callous-unemotional * Child behavior problems * Child psychiatry DOI 10.1007/s10826-009-9337-z

The impact of prosocial and adaptive behaviors and postconflict factors on former Sierra Leonean child soldiers' mental health outcomes is examined. Findings show that community acceptance is linked to improvement in internalizing problems. Externalizing of problems and suggestions regarding psychosocial interventions are presented.

Background: Although previous research has established a direct impact of natural disasters on child mental health, there is limited knowledge on the underpinning mechanisms, particularly when there has been the loss of a parent. Aims: To establish: (a) the rates of behavioural and emotional problems of school-aged children who had lost their parents in the 2003 earthquake in Iran, compared with children from intact families who attended the same schools; (b) the relationship between the psychopathology of the surviving parents' and children's behavioural and emotional problems; and (c) whether this relationship was compounded by socioeconomic factors. Methods: Eighty six children of 7-13 years who had lost a parent in the earthquake four years earlier were compared with 80 matched children from intact families. The teacher and parent versions of the Strengths and Difficulties Questionnaire (SDQ) were used as measures of behavioural and emotional problems. Parents' psychopathology was established by the Self Report Questionnaire (SRQ). Results: Behavioural and emotional problems were significantly higher in children who had suffered parental loss than in the control group. There was a significant association between parent-rated SDQ and SRQ scores. Parental death was found to interact with socioeconomic variables in predicting children's behavioural and emotional problems and surviving parents' mental health problems. Conclusions: After natural disasters, bereaved children and their surviving parents are at risk of developing mental health problems, and social adversities increase this risk.

We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child's health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs. Keywords Children with special health care needs * Financial burden * National Survey of Children with Special Health Care Needs * Family centered care * Health expenditures DOI 10.1007/s10826-009-9286-6

Inconsistency in parenting is a factor that may influence children's mental health. A questionnaire, measuring three parental inconsistencies (temporal, situational, and father-mother inconsistency) was administered to adolescents in nine countries to assess its association with adolescents' psychological disorders. The results show that parental inconsistency varies across cultures. Temporal inconsistency is not correlated with the other two inconsistencies. Temporal and father--mother inconsistencies, but not the situational inconsistency, were associated with adolescents' psychological disorders. The associations between parental inconsistency and psychological disorders differed across cultures. Keywords Inconsistency * Ambivalence * Predictability * Parenting * Culture * Mental health DOI 10.1007/s10826-009-9339-x

This study investigated the relationship of skin conductance response (SCR) to a child psychopathy measure. Blunted electrodermal activity is a theoretically important characteristic of psychopathy, but it has not been fully explored in preadolescents or females. The authors tested the hypothesis that reduced SCR magnitude is associated with psychopathic-like traits in boys and girls. Participants were drawn from an ethnically diverse community sample of 9- to 10-year-old twins. Given the fact that members of each twin pair were rated by the same individual (i.e., their caregiver) on the Child Psychopathy Scale, the authors examined individual differences at the within-family level. Skin conductance data were collected during a passive auditory task consisting of 75-dB tones as well as miscellaneous sounds (e.g., baby cries, bird noises, and speech-like stimuli). Reduced SCR magnitude (hyporeactivity) was characteristic only of boys with higher psychopathy scores. More specifically, electrodermal hyporeactivity was linked to the interpersonal facet of psychopathy, suggesting that it is a biological marker of a manipulative and deceitful orientation in males. No association was found between SCRs and psychopathic traits in girls, indicating the importance of sex specific etiologies of psychopathy in childhood. Keywords: psychopathy, electrodermal activity, skin conductance, orienting, sex differences DOI: 10.1037/a0017777

This study applied the distillation and matching model to 322 randomized clinical trials for child mental health treatments. The model involved initial data reduction of 615 treatment protocol descriptions by means of a set of codes describing discrete clinical strategies, referred to as practice elements. Practice elements were then summarized in profiles, which were empirically matched to client factors (i.e., observed problem, age, gender, and ethnicity). Results of a profile similarity analysis demonstrated a branching of the literature into multiple problem areas, within which some age and ethnicity special cases emerged as higher order splits. This is the 1st study to aggregate evidence-based treatment protocols empirically according to their constituent treatment procedures, and the results point both to the overall organization of therapy procedures according to matching factors and to gaps in the current child and adolescent treatment literature. Keywords: evidence-based, practice elements, common elements, distillation, matching

One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis tree, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed. Keywords: specific phobias, children and adolescents, randomized control trial, cognitive behavior therapy, treatment outcome

This nonexperimental study used mixed-effects regression models to examine relations among supervisor adherence to a clinical supervision protocol, therapist adherence, and changes in the behavior and functioning of youths with serious antisocial behavior treated with an empirically supported treatment (i.e., multisystemic therapy [MST]) 1 year posttreatment. Participants were 1,979 youths and families treated by 429 clinicians across 45 provider organizations in North America. Four dimensions of clinical supervision were examined. Mixed-effects regression model results showed that one dimension, supervisor focus on adherence to treatment principles, predicted greater therapist adherence. Two supervision dimensions, Adherence to the Structure and Process of Supervision and focus on Clinician Development, predicted changes in youth behavior. Conditions required to test hypothesized mediation by therapist adherence of supervisor adherence effects on youth outcomes were not met. However, direct effects of supervisor and therapist adherence were observed in models including both of these variables. Keywords: evidence-based treatment, clinical supervision, implementation, dissemination

This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care, 51% were so placed within 3 months of their 1st crisis screening, with an additional 22% placed between 3 and 6 months after screening. Risk behavior and functioning, psychiatric hospitalization following screening, older age, placement type, and caregiver's capacity for supervision were associated with increased residential placement. The findings highlight the importance of early identification and treatment of behavior and functioning problems following a crisis episode among children and youth in state custody to reduce the need for subsequent residential placement. Having an inpatient psychiatric episode following a crisis episode places children at greater risk for residential placement, suggesting that the hospital is an important point for diversion programs. Children and youth in psychiatric crisis may also benefit from efforts to include their families in the treatment process. Keywords: residential care, children and youth in state custody, psychiatric crisis

Aversion to eye contact is a common behavior of individuals diagnosed with Fragile X syndrome (FXS); however, no studies to date have attempted to increase eye-contact duration in these individuals. In this study, we employed a percentile reinforcement schedule with and without overcorrection to shape eye-contact duration of 6 boys with FXS. Results showed that although aversion to eye contact is often thought to be unamenable to change in FXS, it can be shaped in some individuals using percentile schedules either alone or in combination with overcorrection. DESCRIPTORS: eye contact, Fragile X syndrome, overcorrection, percentile schedules, shaping

The purpose of the present study was to use video modeling to teach children with autism to engage in reciprocal pretend play with typically developing peers. Scripted play scenarios involving various verbalizations and play actions with adults as models were videotaped. Two children with autism were each paired with a typically developing child, and a multiple-probe design across three play sets was used to evaluate the effects of the video modeling procedure. Results indicated that both children with autism and the typically developing peers acquired the sequences of scripted verbalizations and play actions quickly and maintained this performance during follow-up probes. In addition, probes indicated an increase in the mean number of unscripted verbalizations as well as reciprocal verbal interactions and cooperative play. These findings are discussed as they relate to the development of reciprocal pretend-play repertoires in young children with autism. DESCRIPTORS: autism, pretend play, video modeling

We investigated the psychosocial well-being of children in HIV/AIDS-affected families in rural China from the child's and caregiver's perspectives. Semi-structured interviews were conducted among children living in HIV/AIDS-affected families (n = 16), their caregivers (n = 16) and key community informants (n = 5). Our findings showed that all of the children relied heavily on caregivers and peers to gain psychological support. Children's psychosocial problems included fear, anxiety, grief, and loss of self-esteem and confidence. Stigma towards children existed, including isolation, ignorance and rejection. Our study illustrates that HIV/ AIDS has impacted negatively on the psychosocial well-being of children. These findings can be used as preliminary data supporting more researches to profoundly explore the psychosocial impact of HIV/AIDS on children and appropriately indicate the need for interventions. Keywords HIV/AIDS * Parent * Children * Psychosocial influence * Qualitative research

Despite continued efforts by researchers, a gap still exists in our understanding of the psychological, social, and emotional adjustment of gifted students. Historically, research and education of the gifted has focused on cognitive variables, with less attention given to the social and emotional needs of these students. The current study used data from the full Add Health data set to examine how protective factors moderated depression differently for gifted and nongifted adolescents. Results of the study indicate that gifted students are significantly less depressed than nongifted students, and all of the protective factors moderated depression for both groups. Future research should examine additional indicators of psychosocial well-being provide a more comprehensive framework for understanding the social and emotional development of gifted and nongifted adolescents. Putting the Research to Use: Empirical research examining the unique social and emotional needs of gifted adolescents is at a critical juncture. Both educators and researchers have become increasingly aware that giftedness, in whatever form, has unique influences on the social and emotional development of gifted adolescents. In line with previous findings, results in the current study suggest that for both gifted and nongifted adolescents, social support at home and at school can play an important role in reducing problems (i.e, depression) and at the same time that both gifted and nongifted adolescents live (Bronfenbrenner, 1977). Keywords: gifted; depression; protective factors; psychosocial well-being; adolescents

Gaining a better understanding of the types of child symptomatology that predict age at first admission and risk for readmission to a child psychiatric inpatient facility could help to inform the focus of intervention. Accordingly, the current study examined whether internalizing and externalizing behavior problems, alone or in combination, were associated with age at first admission and risk for repeat admission. Analyses were based on a sample of 372 children (M = 9.13 years, SD = 1.91) admitted to an acute psychiatric inpatient facility. Internalizing behavior was associated with a later age at admission, but unrelated to repeat admission. Externalizing behavior was associated with an earlier age at admission and increased risk for repeat admission. Co-occurring internalizing and externalizing behavior problems were associated with increased risk for repeat admission, but were unrelated to age at first admission. Implications for findings are discussed. Keywords: internalizing, externalizing, child inpatient, readmission

Children with antisocial, aggressive and disruptive behaviour problems are among the most frequent referrals to mental health services. These young people and their families present with a range of adverse contextual factors and can prove challenging to engage. We examined the characteristics of children with conduct problems, treatment participation, and the impact of telephone reminder calls. Consecutive referrals (N = 262) to two child and youth mental health services were randomly assigned to either a reminder call condition or service as usual. In comparison to referrals without conduct problems, conduct problem children presented with greater sources of psychosocial adversity, attended fewer initial appointments and were at greater risk of treatment refusal. Importantly, telephone reminder calls significantly increased treatment attendance, though only for participants with elevated conduct problems. Telephone reminder calls, however, had no impact on treatment refusal, regardless of conduct problem status. The findings highlight a straightforward approach for enhancing treatment participation among a group that has been challenging for mental health services. Keywords Conduct problems * Treatment attendance * Attrition * Reminder calls * Mental health service

OBJECTIVE. Nonhypothesis-based MRI-analysis techniques including deformation-based morphometry and automated tissue segmentation have suggested that preterm infants at term-equivalent age have reduced tissue volume in the basal ganglia and thalami, which is most apparent among infants with supratentorial lesions. The aim of our study was to test this hypothesis by direct measurement of thalamic and lentiform nuclei volumes in preterm infants at term-equivalent age and term-born controls using manual volumetry. DESIGN/METHODS. Forty preterm infants at term-equivalent age (median gestational age: 29.5 weeks; median birth weight: 1.3 kg) and 8 term-born controls were examined using a 3-T Philips (Best, Netherlands) system. T1-weighted volume images and T2-weighted fast-spin echo pseudovolumes were acquired. There was no significant difference in postmenstrual age at image acquisition between the 2 groups. ImageJ 1.34 (National Institutes of Health, Bethesda, MD) was used for manual segmentations. RESULTS. The median thalamic and lentiform nuclei volumes for preterm infants at term-equivalent age were 13.6 and 3.07 [cm.sup.3], respectively, significantly smaller than term-control volumes of 16.3 and 5.6 [cm.sup.3], respectively. Ten preterm infants at term-equivalent age had supratentorial lesions (intraventricular hemorrhage, periventricular leukomalacia, or hemorrhagic parenchymal infarction), and the median thalamic and lentiform volumes for this group were 10.4 and 1.7 [cm.sup.3], respectively. When this group was excluded, the remaining infants who had mild or moderate diffuse excessive high signal intensity in the white matter on T2-weighted images had a smaller, yet significant, volume reduction compared with controls. Tissue volumes were not related to weight and gestational age at birth. CONCLUSIONS. Manual volumetry confirms that preterm infants at term-equivalent age have reduced thalamic and lentiform volumes compared with controls. This was most marked among infants with supratentorial lesions but was also seen among those with nonfocal white matter abnormalities. Key Words basal ganglia and thalamus, preterm infants, magnetic resonance volumetry, THE INCREASING SURVIVAL of premature infants is associated with an increased risk of cognitive and behavioral disorders. (1,2) This leads to the investigation of the cortex, white matter (WM), basal [...]

BACKGROUND: A concern persists that children's exposure to mercury vapor from dental amalgams produces neurotoxicity. OBJECTIVE: Our goal was to compare the neuropsychological function of children, without prior exposure to [...]

The authors tested the hypothesis that children who are maltreated earlier in life are at greater risk for poor psychological functioning in adulthood than those maltreated later in life. Age of onset of maltreatment was assessed with 3 classifications: (a) continuous (ages 0-11 years); (b) dichotomous (early [ages 0-5 years] vs. later [ages 6-11 years]); and (c) developmental (infancy [ages 0-2 years], preschool [ages 3-5 years], early school age [ages 6-8 years], and school age [ages 9-11 years]). Individuals with documented cases of physical and sexual abuse and neglect prior to age 12 (N = 496) were followed up and assessed in adulthood. Results indicated that an earlier onset of maltreatment, measured dichotomously and developmentally, predicted more symptoms of anxiety and depression in adulthood, while controlling for gender, race, current age, and other abuse reports. Later onset of maltreatment, measured continuously or developmentally, was predictive of more behavioral problems in adulthood. Implications for the assessment of maltreated children, the prevention of adult psychopathology, and the classification of age of maltreatment onset are discussed. Keywords: age of onset, child maltreatment, longitudinal, mental health, risk factors

This study examined the effectiveness of a self-administered behavioural family intervention (BFI) for parents of toddlers, within the context of a regular telephone counselling service provider. Telephone counsellors were trained in the delivery of BFI, and 110 mothers of toddlers completed the intervention. There were significant short-term effects of intervention in terms of child behaviour problems and parenting style, parenting confidence and anger. In addition, there were improvements in mother's personal adjustment, and lower levels of parenting conflict. The intervention effects were maintained at 3-month follow-up. The results provide support for the effectiveness of self-administered BFI, and have implications for the population level delivery of behavioural family interventions. Keywords: Telephone counselling; Effectiveness; Child behaviour problems

Cognitive models of depression have been well supported with adults, but the developmental origins of cognitive vulnerability are not well understood. The authors hypothesized that temperament, parenting, and negative life events in childhood would contribute to the development of cognitive style, with withdrawal negativity and negative parental feedback moderating the effects of negative life events to predict more depressogenic cognitive styles. These constructs were assessed in 289 children and their parents followed longitudinally from infancy to 5th grade; a subsample (n = 120) also participated in a behavioral task in which maternal feedback to child failure was observed. Results indicated that greater withdrawal negativity in interaction with negative life events was associated with more negative cognitive styles. Self-reported maternal anger expression and observed negative maternal feedback to child's failure significantly interacted with child's negative events to predict greater cognitive vulnerability. There was little evidence of paternal parenting predicting child negative cognitive style. Keywords: cognitive vulnerability, temperament, parenting, stress

This study focuses on the impacts of serial transitions on externalized and internalized behavior disorders, anxiety, and depression among children in child protection services. The research was carried out with a sample of 741 children. The findings demonstrate that the number of times a family is blended is a stronger predictive factor for children's adjustment than is the family structure at the time of the interview. In predicting externalized and internalized behavior problems among children, however, the effect of family structure disappears in favor of the variables associated with family functioning and family climate.

One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates children's psychological symptoms and child welfare service (CWS) patterns to understand how children's needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to children's needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed. Keywords: sexual abuse, NSCAW, latent profile analysis, child welfare services

Background: Homeless families are an increasing but marginalised part of society. They have diverse and complex needs that have often not been addressed by the available services. There is some evidence that psychosocial factors continue to be detrimental to the mental health of these families even after rehousing. Method: Thirty-five homeless families were assessed on their mental health (Hospital Anxiety and Depression Scale, Eyberg Child Behaviour Inventory Scale, Health of the Nation Outcome Scales for Children and Adolescents), parenting problems (Parenting Daily Hassles Scale), and service satisfaction (semi-structured interview) following admission to two homeless hostels, and four months later, when most families (69%) had been rehoused in the community. Results: Children and their mothers continued to experience high rates of mental health problems whilst resident in the hostels and after rehousing. However, a proportion of parents expressed a subjective improvement, which was often associated with their housing and social circumstances. A diverse range of further needs was described. Conclusions: There is a need to address the complex problems experienced by these families, with housing only forming one aspect of this provision. Interagency strategy, commissioning and services are required to meet the needs of this vulnerable group of parents and children.

A study was conducted to examine the role of specialty mental health care as provided by community-based, usual-care practice settings in predicting out-of-home placements among children served by a child welfare and juvenile justice system. It was found that improved systematic screenings for mental health problems and access to specialty mental health care for children referred for in-home child welfare and juvenile justice case management services are promising strategies for reducing out-of-home-placements.

VIQ-PIQ differences have been studied in children with autism and Asperger syndrome but have not been studied in a separate group of children with PDD-NO, although, PDD-NOS has a much higher prevalence rate than autism and deficits in communication and social interaction are severe. The Wechsler Intelligence Scale for Children-Revised (WISC-R) was administered to 100 children, aged 6-12 years, with PDD-NOS (n = 76), autism (n = 13), and Asperger syndrome (n = 11). PDD-NOS was diagnosed using explicit research criteria. No overall differences between VIQ and PIQ were found in PDD-NOS and autism. Peaks in the subtest scores on Information, Similarities, Picture Arrangement, and Mazes, and troughs in the subtest scores on Comprehension, Digit Span, and Coding were demonstrated in children with PDD-NOS. Their score on the Freedom from Distractibility factor was lower than the scores on the Verbal Comprehension factor and the Perceptual Organization factor. Children with PDD-NOS seemed to have a similar VIQ-PIQ profile as children with autism, and on the subtest level children with PDD-NOS showed some similarities to children with Asperger syndrome or autism. It was not possible to distinguish PDD-NOS from autism or Asperger syndrome by using IQ scores. KEY WORDS: pervasive developmental disorders; autism; asperger syndrome; PDD-NOS; intelligence; WISC-R.

This article describes a linked set of activities designed to address the present 'science-to-service' gap in evidence-based practice from the perspective of the nonprofit child mental health agency: (a) implementing 'systems-of-care' principles; (b) logic modeling; (c) strategic partnerships with external researchers; (d) selective, in-depth program evaluation; (e) critical comparison with a limited number of evidence-based practice models of national significance; and (f) internal and external dissemination activities oriented to evidence-based practice. Implications are drawn both for continuous quality improvement of existing clinical services and for the potential for agencies to contribute high quality, science-based information to child mental health services, singly and through the future development of a national network of experimenting child mental health agencies. Keywords: evidence-based practice, child mental health, research-treatment integration, non-profit agency, research utilization