The purpose of this paper is to describe the implementation of a school-based trauma-specific mental health program in New York City following the terrorist attacks on September 11, 2001. This program aimed to serve children most at risk for developing mental health problems as a result of physical proximity (e.g., evacuation from schools surrounding the World Trade Center) to the trauma. As we present the components of the program, we will review the literature that guided our decision making. The ongoing struggle between searching for answers from established science and immediate needs in a crisis is highlighted. Lastly, a discussion of the lessons learned and recommended next steps is presented.
This paper presents a comprehensive review of research linking single-parent family structure to parenting processes, maternal well-being, and child developmental outcomes among African Americans. The approaches used to study these families, related methodological and conceptual concerns, and the factors linked to maternal well-being, effective parenting processes, family functioning, and child outcomes are addressed. Much work remains to be done on conceptualizing and assessing parenting processes among African Americans in general and single African American mothers in particular. Researchers must examine more carefully the circumstances that foster or impede successful parenting among these mothers. Studies also are needed to disentangle the interactions between economic stress and parenting behavior and to determine the extent to which the findings can be applied to middle-income single African American parents.
This paper reviews key findings on juvenile mental health problems in boys, psychopathy, and personality traits, obtained in the first 14 years of studies using data from the Pittsburgh Youth Study. This is a study of 3 samples, each of about 500 boys initially randomly drawn from boys in the 1st, 4th, and 7th grades of public schools in Pittsburgh. The boys have been followed regularly, initially each half year, and later at yearly intervals. Currently, the oldest boys are about 25 years old, whereas the youngest boys are about 19. Findings are presented on the prevalence and interrelation of disruptive behaviors, ADHD, and depressed mood. Results concerning risk factors for these outcomes are reviewed. Psychological factors such as psychopathy, impulsivity, and personality are described. The paper closes with findings on service delivery of boys with mental health problems.
Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.
This article updates the only previous systematic literature review of child outcomes of nonabusive and customary physical punishment by parents. The outcomes differ by methodologic, child, and subcultural factors as well as by how the physical punishment was used. All six studies that used clinical samples (including four randomized clinical studies) and all three sequential-analysis studies found beneficial outcomes, such as reduced noncompliance and fighting, primarily when nonabusive spanking was used to back up milder disciplinary tactics in 2- to 6-year olds. Five of eight longitudinal studies that controlled for initial child misbehavior found predominantly detrimental outcomes of spanking. However, those detrimental outcomes were primarily due to overly frequent use of physical punishment. Furthermore, apparently detrimental outcomes have been found for every alternative disciplinary tactic when investigated with similar analyses. Such detrimental associations of frequent use of any disciplinary tactic may be due to residual confounding from initial child misbehavior. Specific findings suggest discriminations between effective and counterproductive physical punishment with young children. More research is needed to clarify the role of spanking and alternative disciplinary tactics in control system aspects of parental discipline.
This review summarizes the literature on the relationship between marital conflict and child maladjustment with an emphasis on variables that qualify, explain the association, or both. Following a historical review, the modest findings on the strength of the association between marital conflict and child maladjustment is explored. The definition of marital conflict is clarified through specification of its various dimensions (frequency, intensity, content, resolution). The role of variables that serve to moderate and/or mediate the relationship between marital conflict and child maladjustment are elaborated. Mediating models include exposure theories (Modeling, Cognitive-Contextual effects: appraisal of threat and blame, and Emotional Insecurity) and changes in the parent-child relationship (Spillover). Variables that moderate or qualify the relationship include children's cognitions and behaviors, contextual factors, and demographic differences. A model is presented summarizing these mechanisms. Research recommendations are proposed and the clinical implications of this literature are addressed.
A better understanding of what leads youth to initially engage in antisocial behavior (ASB) and more importantly persist with such behaviors into adulthood has significant implications for prevention and intervention efforts. A considerable number of studies using behavioral and neuroimaging techniques have investigated abnormalities in reward and punishment processing as potential causal mechanisms underlying ASB. However, this literature has yet to be critically evaluated, and there are no comprehensive reviews that systematically examine and synthesize these findings. The goal of the present review is twofold. The first aim is to examine the extent to which youth with ASB are characterized by abnormalities in (1) reward processing; (2) punishment processing; or (3) both reward and punishment processing. The second aim is to evaluate whether aberrant reward and/or punishment processing is specific to or most pronounced in a subgroup of antisocial youth with psychopathic features. Studies utilizing behavioral methods are first reviewed, followed by studies using functional magnetic resonance imaging. An integration of theory and research across multiple levels of analysis is presented in order to provide a more comprehensive understanding of reward and punishment processing in antisocial youth. Findings are discussed in terms of developmental and contextual considerations, proposed future directions and implications for intervention.
This article explores the feasibility of using standardized psychometric methods in the initial stages of an investigation of child sexual abuse; methods that are less intrusive and therefore less damaging to children and their families. We review the complex conceptual and research issues that arise from attempts to assess the many-sided aspects of child sexual maltreatment. Among those considered in both the clinical and research spheres are problems of definition and diagnosis; limitations of clinical interviews, and a variety of direct and indirect psychological instruments used for investigating sexual maltreatment and risk assessment; the inadequacies of experimental designs; and also the political, practical, and ethical restraints that hinder research in this area. It is argued that there is insufficient evidence based on controlled studies or standardized normative tests to advocate any simple, unidimensional methodology for the screening task. However, recommendations are put forward for the cautious, conjoint use of several procedures in a multidimensional approach to assessing child sexual abuse. Suggestions are also made for future research and development.
Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.
Many clinicians and researchers have speculated that child sexual abuse and conduct disorder co-occur frequently, yet no systematic reviews of literature have specifically addressed both these conditions. To estimate the prevalence of sexual abuse among children with conduct disorder, the pertinent literature was systematically reviewed. Ten databases were searched, supplemented with hand search of reference lists from retrieved papers. Blind assessments of study eligibility and quality were conducted by two independent researchers. Disagreements were resolved by consensus. Twenty-three studies meeting minimum quality criteria that were enough to insure objectivity and not to invalidate results and including 7,256 participants with either conduct disorder or child sexual abuse were examined. The prevalence of child sexual abuse among participants with conduct disorder was 27 %; however, such figure might be underestimated due to selection, sampling, and recall biases; poor assessment methods; and narrow definitions of abuse in included studies. Participants with conduct disorder, compared with healthy individuals, reported higher rates of child sexual abuse. However, compared with other psychiatric populations, they reported similar or lower rates. There was also some evidence suggesting that children with conduct disorder might be more likely to report child physical abuse. Female participants with conduct disorder, compared with males, were significantly more likely to report child sexual abuse. Youths with conduct disorder are at risk of being (or having been) sexually abused, although such risk seems to be neither more specific to nor stronger for these individuals, compared with people with other psychiatric disorders.
Three definitional issues regarding children exposed to domestic violence are examined. First, the multiple ways in which a child can be exposed to violence is discussed. A taxonomy of 10 types of exposure is proposed. Nine key characteristics of domestic violence, as they relate to children and children's exposure, are then outlined. The third issue addressed concerns why children who are exposed to domestic violence can be considered victims of child maltreatment. These children, by nature of their experience in the home, are psychologically maltreated and are also at high risk for physical abuse and some risk for sexual abuse. Empirical questions concerning these definitions and taxonomies and their interrelations are discussed.
This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.
Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate "knowns and unknowns" regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.
This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD-substance-abuse relation. These studies have generally found that the ADHD-substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.
Although childhood sexual abuse and childhood physical abuse (CSA and CPA) have severe psychopathological consequences, there is little evidence supporting psychotherapeutic interventions for adolescents who have experienced CSA or CPA. To provide a treatment tailored to the specific needs of adolescents suffering from abuse-related posttraumatic stress disorder (PTSD), we modified Cognitive Processing Therapy (CPT) by adding new treatment modules and changing the therapy setting. To evaluate the feasibility and efficacy of Developmentally Adapted CPT (D-CPT), we treated 12 adolescents suffering from PTSD secondary to CSA or CPA. Patients were assessed prior to treatment (t0), post-treatment (t1), and 6 weeks after treatment (t2). Assessments included the Clinician-Administered PTSD Scale (CAPS), the UCLA PTSD Index (UCLA), the Children's Depression Inventory (CDI), the Adolescent Dissociative Experiences Scale (A-DES), and the Borderline Symptom List (BSL-23). MANOVAs revealed that posttraumatic stress measurements and associated symptom measurements significantly differed across time points. When comparing t0 with t2, Cohen's d was large with respect to the CAPS scores (d = 1.45, p < .001) and the UCLA scores (d = 1.91, p < .001). Cohen's d had a medium magnitude with respect to the CDI scores (d = .78, p < .001), the A-DES scores (d = 0.64, p < .05), and the BSL-23 scores (d = 0.74, p < .01). D-CPT has the potential to reduce PTSD symptoms and comorbid psychopathology in adolescents with histories of CSA or CPA.
Child abuse is a major social concern around the world. Important to tackling the problem is an understanding of the mechanisms contributing to abusive parenting. This article brings together research on the cognitive variables associated with abusive or high-risk parenting. Considered are dysfunctional child-centered and parent-centered cognitions as potentially critical correlates of abusive behavior. The development of dysfunctional cognitions is also explored. Cognitive vulnerabilities alone are typically not sufficient for the occurrence of abuse. Interactions with additional factors, such as an ability to inhibit aggression, problem-solving capabilities, parenting skills, social isolation, and societal context are examined.
Polygamy represents expanded family structures that are based on marriages involving a husband with 2 or more wives. Interestingly, polygamy is legally and widely practiced in 850 societies across the globe. In the last 2 decades, polygamy has been the focus of a significant growth in public, political, and academic awareness. Indeed, several quantitative and qualitative research articles and theoretical papers have emerged during this period, particularly concerning the effects of this form of marital structure on behavioral, emotional, and academic adjustment of children. However, to date, no researcher has provided a summary of the extant literature. Thus, the purpose of this comprehensive literature review is to summarize findings and to discuss implications of empirical studies that have examined whether polygamous marital structures are beneficial or harmful to children in comparison with children raised in monogamous marital structures. This review includes a summary of the findings from all quantitative and qualitative studies in the extant literature that have examined the effect of polygamy on children's outcomes.
This paper describes Skills for Academic and Social Success (SASS), a cognitive-behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their child's anxiety. Initial findings regarding the program's effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.
Youth with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience academic impairment, including lower grades than their peers and elevated risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, and it is therefore essential to understand the extent to which medication use improves long-term academic functioning. This paper reviews the literature on the relation between long-term medication use and the academic outcomes of youth with ADHD. A systematic literature search was conducted to identify pertinent studies published since 2000 that followed youth with ADHD for 3 or more years. Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies = 8,721). These studies demonstrate that long-term medication use is associated with improvements in standardized achievement scores. However, the magnitude of these improvements is small and the clinical or educational significance is questionable. Evidence for long-term improvements in school grades and grade retention is less compelling. This review highlights methodological considerations in providing directions for future research. The importance of using multiple sources to gather information about medication adherence is discussed, including use of methodologies such as electronic monitors, rather than relying solely on parent report or chart review. Future research should also examine a range of medication adherence definitions in order to determine whether age of onset, duration of use, dose, and/or consistency of use moderates the relation between long-term medication use and academic outcomes.
Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,
2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.
Behavioral parent training (BPT) is a widely used, evidence-based treatment for externalizing child behaviors. However, the ability of BPT programs to be maximally effective remains limited by relatively low rates of acceptance, attendance, and adherence to treatment. Previous reviews have focused on a variety of demographic and mental health characteristics of parents and children that are predictive of poor outcomes in BPT. This paper focuses instead on consideration of parental social cognitions, and how incorporation of these cognitions may, or may not, be useful in advancing the effectiveness of BPT. We first review evidence suggesting limited incremental effects to incorporating parental cognitions within the context of BPT programs. Then, we examine the role of two particular types of parental social cognitions, attributions and parenting efficacy, in relation to the initial stages of accepting and engaging in BPT. We conclude by noting limitations in available research on the links between parental social cognitions and BPT, and we outline a number of potentially useful directions that may clarify whether or not parental social cognitions should be accorded greater attention either in the initial stages or throughout BPT programs.
Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome research in this area. This review focuses on two key issues within the child PTSD literature-namely the role of parents in treatment and the timing of intervention. The issue of parental involvement in the treatment of child PTSD is a question that is increasingly being recognized as important. In addition, the need to find a balance between providing early intervention to at risk youth while avoiding providing treatment to those youth who will recover spontaneously has yet to be addressed. This paper outlines the rationale for and the development of a trauma-focused CBT protocol with separate parent and child programs, for use with children and adolescents experiencing PTSD following an accidental injury. The protocol is embedded within an indicated intervention framework, allowing for the early identification of youth at risk within a medical setting. Two case studies are presented in order to illustrate key issues raised in the review, implementation of the interventions, and the challenges involved.
In order to address the mental health disparities that exist for Latino adolescents in the United States, psychologists must understand specific factors that contribute to the high risk of mental health problems in Latino youth. Given the significant percentage of Latino youth who are immigrants or the children of immigrants, acculturation is a key factor in understanding mental health among this population. However, limitations in the conceptualization and measurement of acculturation have led to conflicting findings in the literature. Thus, the goal of the current review is to examine and critique research linking acculturation and mental health outcomes for Latino youth, as well as to integrate individual, environmental, and family influences of this relationship. An integrated theoretical model is presented and implications for clinical practice and future directions are discussed.
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.
This article examines potential theoretical constraints on resilience across levels of risk, time, and domain of outcome. Studies of resilience are reviewed as they relate to the prevalence of resilience across levels of risk (e.g., single life events vs. cumulative risk), time, and domains of adjustment. Based on a thorough review of pertinent literature, we conclude that resilience, as a global construct, appears to be rare at the highest levels of risk, and that resilience may benefit from a narrower conceptualization focusing on specific outcomes at specific timepoints in development. The implication of this conclusion for future research and intervention efforts is then discussed.