David J. Kolko

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (157)580.65 Total impact

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    ABSTRACT: Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality. Suicide attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention. To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child. In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a suicide attempt, were followed up for a mean of 5.6 years. The primary outcome was a suicide attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression). Among the 701 offspring, 44 (6.3%) had made a suicide attempt before participating in the study, and 29 (4.1%) made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of suicide attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband attempt on offspring suicide attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder. Parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.
    JAMA Psychiatry 12/2014; · 12.01 Impact Factor
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    ABSTRACT: Interpersonal violence (IPV) is common in children with a disruptive behavior disorder (DBD) and increases the risk for greater DBD symptom severity, callous–unemotional (CU) traits, and neuroendocrine disruption. Thus, IPV may make it difficult to change symptom trajectories for families receiving DBD interventions given these relationships. The current study examined whether IPV prior to receiving treatment for a DBD predicted trajectories of a variety of associated outcomes, specifically DBD symptoms, CU traits, and cortisol concentrations. Boys with a DBD diagnosis (N = 66; age range = 6–11 years; 54.5% of whom experienced IPV prior to treatment) of either oppositional defiant disorder or conduct disorder participated in a randomized clinical trial and were assessed 3 years following treatment. Multilevel modeling demonstrated that prior IPV predicted smaller rates of change in DBD symptoms, CU traits, and cortisol trajectories, indicating less benefit from intervention. The effect size magnitudes of IPV were large for each outcome (d = 0.88–1.07). These results suggest that IPV is a predictor of the long-term treatment response for boys with a DBD. Including trauma-focused components into existing DBD interventions may be worth testing to improve treatment effectiveness for boys with a prior history of IPV.
    Journal of Traumatic Stress 09/2014; · 2.72 Impact Factor
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    ABSTRACT: This study adapts the Posterior Probability of Diagnosis (PPOD) Index for use with screening data. The original PPOD Index, designed for use in the context of comprehensive diagnostic assessments, is overconfident when applied to screening data. To correct for this overconfidence, we describe a simple method for adjusting the PPOD Index to improve its calibration when used for screening. Specifically, we compare the adjusted PPOD Index to the original index and naïve Bayes probability estimates on two dimensions of accuracy, discrimination and calibration, using a clinical sample of children and adolescents (N = 321) whose caregivers completed the Vanderbilt Assessment Scale to screen for attention-deficit/hyperactivity disorder and who subsequently completed a comprehensive diagnostic assessment. Results indicated that the adjusted PPOD Index, original PPOD Index, and naïve Bayes probability estimates are comparable using traditional measures of accuracy (sensitivity, specificity, and area under the curve), but the adjusted PPOD Index showed superior calibration. We discuss the importance of calibration for screening and diagnostic support tools when applied to individual patients.
    Assessment 07/2014; · 2.01 Impact Factor
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    ABSTRACT: To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC). Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 161) or enhanced usual care (EUC; n = 160). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate. DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P < .001) and completion (76.6% vs 11.6%, P < .001), improvement in behavior problems, hyperactivity, and internalizing problems (P < .05 to .01), and parental stress (P < .05-.001), remission in behavior and internalizing problems (P < .01, .05), goal improvement (P < .05 to .001), treatment response (P < .05), and consumer satisfaction (P < .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P < .05 to .01). Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services.
    PEDIATRICS 03/2014; · 5.30 Impact Factor
  • David J Kolko, Ellen Perrin
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    ABSTRACT: Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
    Journal of Clinical Child & Adolescent Psychology 03/2014; · 1.92 Impact Factor
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    ABSTRACT: Objective: Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior. Method: Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined. Results: Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low. Conclusions: Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 02/2014; · 4.85 Impact Factor
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    David J Kolko, Oliver Lindhiem
    Journal of Abnormal Child Psychology 01/2014; · 3.09 Impact Factor
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    ABSTRACT: This study solicited the perspectives of community-based behavioral health practitioners and supervisors about their perceived clinical training needs and preferences using a mixed-methods approach. Forty one participants completed quantitative questionnaires before engaging in qualitative focus groups or interviews. Of those, 34 practitioners participated in a focus group discussion and 7 supervisors participated in semistructured interviews. Quantitative analyses (one-way analysis of variance [ANOVA]; t test) indicated differences in attitude toward the adoption of evidence-based practices across service line, but not role (staff vs. supervisor), with wraparound staff being more open and willing to implement evidence-based practices. Qualitative data were coded by 2 independent coders. Four themes emerged: include training support from trainers, agencies, supervisors, and peers within and across departments; use interactive training methods rather than lecture-based formats; schedule and structure training sessions with an appreciation of the time constraints upon practitioners; and offer training in content areas that are both efficacious and of interest. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
    Professional Psychology Research and Practice 01/2014; 45(3):188. · 1.34 Impact Factor
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    ABSTRACT: Sleep problems and adaptive functioning were examined in children who were exposed to intimate partner violence (IPV). Participants included 100 mothers. Forty mothers experienced IPV and were residing in an IPV shelter with their 6- to 13-year-old child. These mothers reported on their experience of IPV in the presence of their child, their psychopathology symptoms, their child’s adaptive functioning, and their child’s sleep problems. Sixty community-based mothers with 6- to 11-year-old children provided reference values for maternal psychopathology and child sleep problems, which were lower than IPV-exposed mothers’ and children’s values, respectively. Two-thirds (63%) of children exposed to IPV (vs. reference value = 45%) had a sleep problem(s). Increased physical and verbal IPV were associated with increased maternal psychopathology, which was associated with increased child sleep problems. IPV-exposed children with sleep problems demonstrated worse adaptive functioning than children without sleep problems; however, differences may be accounted for by maternal psychopathology. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
    Psychological Trauma Theory Research Practice and Policy 01/2014; 6(3):290. · 0.89 Impact Factor
  • Oliver Lindhiem, Anne Shaffer, David J Kolko
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    ABSTRACT: In the parent intervention outcome literatures, discipline practices are generally quantified as absolute frequencies or, less commonly, as relative frequencies. These differences in methodology warrant direct comparison as they have critical implications for study results and conclusions among treatments targeted at reducing parental aggression and harsh discipline. In this study, we directly compared the absolute frequency method and the relative frequency method for quantifying physically aggressive, psychologically aggressive, and nonaggressive discipline practices. Longitudinal data over a 3-year period came from an existing data set of a clinical trial examining the effectiveness of a psychosocial treatment in reducing parental physical and psychological aggression and improving child behavior (N = 139). Discipline practices (aggressive and nonaggressive) were assessed using the Conflict Tactics Scale. The two methods yielded different patterns of results, particularly for nonaggressive discipline strategies. We suggest that each method makes its own unique contribution to a more complete understanding of the association between parental aggression and intervention effects.
    Journal of Interpersonal Violence 10/2013; · 1.64 Impact Factor
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    ABSTRACT: Offspring of depressed parents are at increased risk for psychiatric disorders. Although bipolar disorder (BD) and major depressive disorder (MDD) are both found in the same families, it is not clear whether transmission to offspring of BD or MDD tends to occur from parents with the same mood disorder subtype. Our primary hypothesis was that the offspring of parents with BD would be at increased risk for BD and other comorbid disorders common to BD, such as anxiety and substance use, relative to the offspring of parents with MDD. The offspring of parents with BD versus those with MDD were also hypothesized to be at greater risk for externalizing disorders (i.e., conduct disorder, attention-deficit hyperactivity disorder, or antisocial personality disorder). Parents (n = 320) with mood disorders and their offspring (n = 679) were studied. Adult offspring were administered the Structured Clinical Interview for DSM-IV Axis I Disorders to establish the presence of psychopathology. Offspring aged 10-18 years were assessed using the School Aged Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version, and parents of children under the age of ten completed the Child Behavioral Checklist. Data were examined using Cox proportional hazard regression. There was no difference in hazard of mood disorders in the offspring of parents with BD as compared to the offspring of parents with MDD. However, a number of other parent and offspring characteristics increased the risk of mood, anxiety, externalizing, and substance use disorders in the offspring, including self-reported childhood abuse in the parent or offspring, offspring impulsive aggression, and the age at onset of parental mood disorder. Mood disorders are highly familial, a finding that appears independent of whether the parent's condition is unipolar or bipolar, suggesting considerable overlap in the heritability of MDD and BD. Although parental characteristics had a limited influence on the risk of offspring psychopathology, reported childhood adversity, be it in the parent or child, is a harbinger of negative outcomes. These risk factors extend previous findings, and are consistent with diathesis-stress conceptualizations.
    Bipolar Disorders 08/2013; · 4.62 Impact Factor
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    ABSTRACT: Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non-attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.
    World psychiatry: official journal of the World Psychiatric Association (WPA) 06/2013; 12(2):149-54. · 12.85 Impact Factor
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    ABSTRACT: We review 85 empirical articles published since 2000 that measured the acquisition and/or utilization of parent management skills and/or child cognitive-behavioral skills in the context of an evidence-based treatment (EBT) for childhood behavior problems. Results showed that: (1) there are no standardized measures of skill acquisition or skill utilization that are used across treatments, (2) little is known about predictors, correlates, or outcomes associated with skill acquisition and utilization, and (3) few studies systematically examined techniques to enhance the acquisition and utilization of specific skills. Meta-analytic results from a subset of 68 articles (59 studies) showed an overall treatment-control ES = .31, p < .01 for skill acquisition and ES = .20, p = ns for skill utilization. We recommend that future research focus on the following three areas: (1) development of standardized measures of skill acquisition and utilization from a "common elements" perspective that can used across EBTs; (2) assessment of the predictors, correlates, and outcomes associated with skill acquisition and utilization; and (3) development of innovative interventions to enhance the acquisition and utilization of cognitive-behavioral and parent management skills.
    Clinical Child and Family Psychology Review 05/2013; · 3.13 Impact Factor
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    ABSTRACT: This study examines the impact of a brief booster treatment administered 3 years after the delivery of an acute treatment in a group (n = 118) of clinically referred boys and girls (ages 6 to 11) originally diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). At the conclusion of the acute treatment and three-year follow-up period (i.e., study month 42), the sample was re-randomized into Booster treatment or Enhanced Usual Care and then assessed at four later timepoints (i.e., post-booster, and 6-, 12- and 24-month booster follow-up). Booster treatment was directed towards addressing individualized problems and some unique developmental issues of adolescence based on the same original protocol content and treatment setting, whereas the Enhanced Usual Care condition involved providing clinical recommendations based on the assessment and an outside referral for services. HLM analyses identified no significant group differences and few time effects across child, parent, and teacher reports on a broad range of child functioning and impairment outcomes. Analyses examining the role of putative moderators or predictors (e.g., severity of externalizing behavior, dose of treatment) were likewise non-significant. We discuss the nature and implications of these novel findings regarding the role and timing of booster treatment to address the continuity of DBD over time.
    Journal of Abnormal Child Psychology 03/2013; · 3.09 Impact Factor
  • Oliver Lindhiem, David J Kolko, Lan Yu
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    ABSTRACT: Using traditional Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (American Psychiatric Association, 2000) diagnostic criteria, clinicians are forced to make categorical decisions (diagnosis vs. no diagnosis). This forced choice implies that mental and behavioral health disorders are categorical and does not fully characterize varying degrees of uncertainty associated with a particular diagnosis. Using an item reponse theory (latent trait model) framework, we describe the development of the Posterior Probability of Diagnosis (PPOD) Index, which answers the question: What is the likelihood that a patient meets or exceeds the latent trait threshold for a diagnosis? The PPOD Index is based on the posterior distribution of θ (latent trait score) for each patient's profile of symptoms. The PPOD Index allows clinicians to quantify and communicate the degree of uncertainty associated with each diagnosis in probabilistic terms. We illustrate the advantages of the PPOD Index in a clinical sample (N = 321) of children and adolescents with oppositional defiant disorder. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Assessment 01/2013; · 2.99 Impact Factor
  • A. Shaffer, O. Lindhiem, D. J. Kolko
    Journal of Emotional and Behavioral Disorders 11/2012; 21(4):277-288. · 1.28 Impact Factor
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    ABSTRACT: In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.
    Journal of Abnormal Child Psychology 07/2012; · 3.09 Impact Factor
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    ABSTRACT: Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) is an evidence-based treatment for families with children aged 5 to 15 years who have been affected by verbal and physical aggression in the family. AF-CBT was designed to address risks for exposure to emotional and physical aggression as well as common clinical consequences of exposure to aggression by taking a family-systems approach to strengthening individual and family functioning. Given the target population, AF-CBT also integrates monitoring of and content related to family safety. This article provides an overview of AF-CBT including a discussion of appropriate populations and modalities, AF-CBT principles, and the theoretical basis of AF-CBT. The treatment is divided into three phases: (a) engagement and psychoeducation, (b) individual skill building, and (c) family applications and routines. The authors review each of these phases, the specific components and content of AF-CBT, and its empirical support. AF-CBT was one of the first treatments for physical aggression to be considered an evidence-based treatment. Information is provided on the opportunities and challenges of applying AF-CBT in schools, cultural considerations in AF-CBT's implementation, and how to obtain training in AF-CBT. Specifically, the authors provide details on the role of school psychologists in the delivery of AF-CBT, for example, as direct service providers or as important referral sources. The authors also provide details on topics that psychologists and schools might want to consider in determining whether AF-CBT is a good fit for them and their setting.
    Journal of Applied School Psychology 07/2012; 28(3):270-293.
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    ABSTRACT: To examine the demographic and clinical correlates of nonsuicidal self-injury. This is a cross-sectional analysis of a longitudinal cohort study of the familial transmission of suicidal behavior, conducted at referral centers in Pittsburgh, Pennsylvania, and New York, New York. Participants included 291 probands with DSM-IV mood disorder, one-half of whom had attempted suicide, and 507 of their offspring. The primary outcome assessed was nonsuicidal self-injury in offspring. Psychosocial correlates of nonsuicidal self-injury were determined by comparing personal, parental, and familial characteristics of offspring with and without nonsuicidal self-injury, assessed using a variety of interview and self-report measures at study entry. Data were collected between August 1998 and August 2007. Of 507 offspring, 7.7% (n=39) had engaged in nonsuicidal self-injury. The most salient correlates of nonsuicidal self-injury on multivariate logistic regression were diagnosis of depression (OR=3.78, P<.001) and greater aggression (OR=1.07, P=.01), depressive symptoms (OR=1.59, P=.009), and suicidal ideation (OR=1.24, P=.004). Parental history of abuse, as well as family histories of suicide attempt and nonsuicidal self-injury, was noncontributory. Nonsuicidal self-injury is associated with the presence and severity of depression, suicidal ideation, and behavioral dysregulation. On multivariate analysis, only individual predictors remained significant; this result is distinct from that for correlates of suicide attempt reported in this sample, for which familial variables played a significant role.
    The Journal of Clinical Psychiatry 06/2012; 73(6):813-20. · 5.81 Impact Factor
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    Oliver Lindhiem, David J Kolko, Yu Cheng
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    ABSTRACT: We describe the development of the probability of treatment benefit (PTB) chart that incorporates, integrates, and extends more recent approaches to describing treatment effects, such as the Reliable Change Index (Jacobson & Truax, 1991) and normative comparisons (Kendall, Marrs-Garcia, Nath, & Sheldrick, 1999), by including parameters that are simultaneously probabilistic and individualized. To illustrate the PTB chart, data are taken from an effectiveness trial (N=139) of a modular treatment for disruptive behavior disorders. The results highlight both individual variability and the probabilistic nature of psychotherapy benefit. Finally, we discuss the utility of the PTB chart in terms of research, policy, and practice implications. Probability tables, such as the PTB chart, have the potential to be used as simple clinical tools to supplement traditional effect sizes and help patients make truly informed decisions about treatment participation.
    Behavior therapy 06/2012; 43(2):381-92. · 2.85 Impact Factor

Publication Stats

4k Citations
580.65 Total Impact Points


  • 1985–2014
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
    • Jesse Brown VA Medical Center
      Chicago, Illinois, United States
  • 2008–2013
    • New York State Psychiatric Institute
      • Anxiety Disorders Clinic
      New York City, New York, United States
  • 1985–2013
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1980–2012
    • Georgia State University
      Atlanta, Georgia, United States
  • 2011
    • Palo Alto University
      • Pacific Graduate School of Psychology
      Palo Alto, CA, United States
  • 2005–2010
    • Columbia University
      • • Department of Psychiatry
      • • Department of Neuroscience
      New York City, New York, United States
  • 2007
    • RTI International
      Durham, North Carolina, United States
    • University of New Hampshire
      • Crimes Against Children Research Center
      Durham, New Hampshire, United States
  • 2006
    • Yale University
      New Haven, Connecticut, United States
  • 1999
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 1995–1996
    • Eastern Washington University
      • Department of Psychology
      Cheney, WA, United States
  • 1990
    • Thomas Jefferson University Hospitals
      Philadelphia, Pennsylvania, United States
  • 1984
    • Brown University
      Providence, Rhode Island, United States