Home visiting for first-time mothers and subsequent pregnancy spacing.

OBJECTIVE: The objective of the study was to determine the association of home visiting with subsequent pregnancy outcomes. STUDY DESIGN: Retrospective study of Ohio mothers delivering their first infant from 2007 to 2009. First, we compared mothers enrolled in home visiting with a matched eligible group. Second, we compared outcomes within home visiting based on program participation (low <25% of recommended home visits, moderate 25 to 75%, high 75 to 100% and very high >100%). Time to subsequent pregnancy within 18 months was evaluated using Cox proportional hazards regression; logistic regression tested the likelihood of subsequent preterm birth. RESULTS: Of 1516 participants, 1460 were matched 1:1 to a comparison mother (n=2920). After multivariable adjustment, enrollment was associated with no difference in pregnancy spacing or subsequent preterm birth. Among those enrolled, moderate vs low participants had reduced risk of repeat pregnancy over 18 months (hazard ratio 0.68, P=0.003). CONCLUSION: Increased pregnancy spacing is observed among women with at least moderate home visiting participation.

Constructive thinking in adolescents with substance use disorders.

This study examined the concurrent validity and clinical correlates of the Constructive Thinking Inventory (CTI), a measure of experiential coping, in 551 adolescents aged 14-18 years with and without Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) substance use disorders (SUDs). The CTI was correlated with depression, anxiety, and conduct problems. After controlling for demographics and comorbid lifetime psychiatric disorders, the CTI scales of Behavioral Coping and Categorical Thinking distinguished adolescents with and without SUDs. Implications of these findings for assessment and treatment are discussed.

Individual traits and family contexts predict sons' externalizing behavior and preliminary relative risk ratios for conduct disorder and substance use disorder outcomes.

An ontogenetic framework for elucidating the etiology of substance use disorders (SUD) requires identifying how individual traits and family contexts combine to increase risk for SUD outcomes. In this study, we examine individual traits in family context to identify processes that account for the relationship between fathers' SUD + status and sons' externalizing behaviors. Results obtained from SUD + (n = 89) and SUD - (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD + status and sons' externalizing behavior scale (EBS) scores 2 years later. Moreover, individual traits, family contextual variables and deviant peer affiliations accounted for 58% of the variance on sons' EBS scores. Also, high risk cluster (HRC) and low risk cluster (LRC) memberships were derived from cluster analyses of the continuous risk factor scores that predicted sons' EBS scores. Preliminary relative risk ratios show that sons classified into the HRC at age 10-12 were at greater risk for DSM-III-R conduct disorder and SUD outcomes at age 16 than sons assigned to the LRC, SUD + or SUD - groups. Implications for selected family-based prevention initiatives are presented.

Hormonal and behavioral homeostasis in boys at risk for substance abuse.

This study modeled the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, family and peer dysfunction on behavioral self-regulation (BSR), in boys at high (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10- through 12-year-old sons of substance abusing fathers (HAR; n = 150) and normal controls (LAR; n = 147). A multidimensional construct of BSR was developed which utilized multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression antisocial personality symptoms and parental physical abuse potential are likely to influence sons' behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD).

Child abuse potential in parents with histories of substance use disorder.

OBJECTIVE: To examine the relationship between parental history of substances use disorders (SUDs) and abuse potential. METHOD: Milner's (1986) Child Abuse Potential Inventory (CAPI) was administered to fathers and mothers (with and without histories of SUDs) of 10- to 12-year-old boys. RESULTS: Fathers and mothers with lifetime histories of SUDs had higher Abuse Scale scores and were more likely to score in the Elevated range (as determined by clinically significant cutoff scores) than parents without such histories. No differences were found between parents with current diagnoses of SUD and those with past (but not current) histories of SUD. Fathers and mothers with a partner who had a history of SUD were more likely to score in the Elevated range, regardless of their own SUD histories. Separate regression models revealed that, for both fathers and mothers, emotional dysregulation (positive and negative affectivity) predicted Abuse Scale scores. Additional contributors to Abuse Scale scores were SUD status in fathers, and lack of involvement with the child in mothers. CONCLUSIONS: History of SUDs in both fathers and mothers increases abuse potential. Contributors to abuse potential differed in fathers and mothers, underscoring the importance of examining parents separately in child maltreatment research.

Remedying the Achilles heel of behavior research and therapy: prescriptive matching of intervention and psychopathology.

Recent calls for eclecticism in clinical practice have been fueled by the putative limitations of behavioral techniques in treating a variety of psychological problems. However, calls for such integration do not appear to be justified for two related reasons. First, the precise conditions under which behavioral interventions are and are not effective have not yet been adequately delineated. Consequently, rejection of behavioral interventions in favor of relatively indiscriminate application of cognitive strategies is premature. Second, behavior therapy has as its hallmark a thorough grounding in inductive empiricism, while cognitive/dynamic theories are wholly based in deductive rationalism. As a result, wholesale acceptance of alternative theories and techniques by behaviorists is both inconsistent and retrogressive. Cognitive interventions have their place, but only when cognitive distortions have been specifically identified. Therefore, refinement of behavioral treatments into prescriptive interventions is warranted. The parameters of prescriptive behavior therapy are described in this paper.

Maltreatment in psychiatrically hospitalized children and adolescents with developmental disabilities: prevalence and correlates.

OBJECTIVE: The goals of this study were (1) to determine the prevalence of child maltreatment in hospitalized children and adolescents with developmental disabilities and concomitant psychiatric disorders, and (2) to identify the contribution of specific mother and child characteristics to the use of more severe disciplinary practices by mothers. METHOD: One hundred thirty-eight psychiatrically hospitalized children and adolescents with developmental disabilities and mothers were assessed using a semistructured interview (Child Abuse and Neglect Interview Schedule) examining factors associated with risk of child maltreatment, and questionnaires measuring maternal and child functioning. The Child Abuse and Neglect Interview Schedule and hospital charts were then used to derive ratings on the prevalence and severity of child maltreatment. RESULTS: Findings revealed that 61% of children had experienced some form of severe maltreatment by a care provider in their lifetime. Regression analysis indicated that interactions between high levels of social functioning and disruptive/oppositional behaviors and younger age in children, and low levels of social support and increased anger reactivity in mothers, were most predictive of mothers' use of severe disciplinary practices. CONCLUSIONS: Maltreatment in psychiatrically hospitalized children and adolescents with disabilities is very prevalent, and it warrants careful clinical assessment. In the psychiatric setting, families in which the child is younger, higher functioning, and behaviorally disruptive, and where mothers have little social support and exhibit increased anger reactivity, are at especially elevated risk.

Drug abuse prevention for high-risk African American children and their families: a review and model program.

In this article we are specifically concerned with the familial and socioeconomic factors that contribute to the exceedingly high prevalence rates of drug abuse in African-American children. In addition to detailing the impact of drug abuse in African-American children and their families, we consider how this critical health problem can be prevented using existing knowledge and strategies known to mental health professionals. A model program entitled Project for a Substance Abuse-Free Environment (SAFE) is outlined. Its objectives are to implement: (a) a broad-spectrum family intervention to empower disadvantaged and high-risk families in their communities: (b) a competency-based skills intervention to increase resilience and decrease drug use and other maladaptive behaviors in at-risk children; (c) alternative activities that will promote self-efficacy, achievement, and self-esteem; (d) a culturally-relevant evaluation plan that includes both formative (process) and summative (outcome) evaluation; (e) a comprehensive approach for assessing project impact; (e) systematic procedures for enhancing the maintenance and generalization of gains in participating children and families.

Maltreatment in psychiatrically hospitalized dually diagnosed adolescent substance abusers.

The medical charts of 150 consecutive admissions of dually diagnosed substance abusing adolescents admitted to a psychiatric hospital were examined to determine the extent and characteristics of maltreatment. Results indicated that 61% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent form of maltreatment, followed by sexual abuse and neglect. Thirty-seven percent of patients experienced multiple forms of maltreatment. Maltreated patients had significantly more hospitalizations than their nonmaltreated counterparts on the same unit. Moreover, the age of maltreated patients was significantly lower than nonmaltreated patients, perhaps indicating an earlier age of onset of psychiatric illness and/or substance abuse. Analyses of parental substance abuse and psychiatric history among the maltreated and nonmaltreated groups revealed no significant findings. Results are discussed in terms of the following: (1) increased risk of subsequent substance abuse in maltreated children; (2) need for systematic assessment of child maltreatment in psychological or psychiatric evaluations; and (3) importance of treatment to deal with abuse or neglect as part of a comprehensive substance abuse intervention strategy.

Parent-child problem-solving interactions in families of visually impaired youth.

Investigated problem-solving and conflict-resolution strategies, an important aspect of family functioning, in visually impaired adolescents and their parents. Visually impaired adolescents were compared to adolescents with spina bifida and a control group of adolescents without disabilities. Parent-adolescent dyads participated in a problem-solving discussion of topics reflecting family disagreement. Videotapes of these discussions were rated for patterns of interaction using the Marital Interaction Coding System (MICS-III). Examination of positive and negative reciprocal patterns of interaction using sequential analyses and contrasting frequencies of specific behavioral codes revealed no differences between groups for adolescents, mothers, and fathers on the problem-solving discussion. Results are discussed in terms of (a) the impact of visual impairment on family functioning and (b) the need to identify those subgroups of visually impaired and their families that may be at heightened risk for maladjustment.

The role of the child in physical abuse: a reappraisal.

Friedrich and Boriskin's (1976) seminal review presented compelling evidence pointing toward the contribution of child factors in heightening risk for physical abuse. Indeed, many authors currently accept that certain child characteristics (e.g., prematurity, low birthweight) can directly lead to abuse. Much of the data in this area, however, is based on methodologically weak designs, and recent findings do not support the premise that children have a major role in the etiology of abuse. There is some suggestion that children with relatively circumscribed features may add to risk in families that already exhibit additional factors predisposing them to maltreatment. This paper re-examines the role of the child in abuse, reviews recent relevant research findings, and offers new directions that research in this area might take.

Etiological models of child maltreatment. A behavioral perspective.

Child abuse and neglect are complex phenomena that require a multidisciplinary perspective. This article describes current etiological formulations of child maltreatment. Three models (ecological, transactional, and transitional) are described that delineate the multiple pathways leading to abuse and neglect. These approaches emphasize the interaction of causative factors in bringing about maltreatment and the importance of high- and low-risk characteristics that differentially influence the development of maltreatment. Behavioral explanations of child maltreatment are also discussed. Particularly relevant here are observational learning, anger control, and coercive family processes. Finally, the implications of our understanding of etiology to assessment, treatment, and prevention are outlined and considered.

Abuse and neglect in psychiatrically hospitalized multihandicapped children.

Medical charts of 150 consecutive admissions of multihandicapped children to a psychiatric hospital were examined to determine the extent and characteristics of abuse and neglect. Results indicated that 39% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent type of maltreatment, followed by neglect and sexual abuse. Maltreated multihandicapped patients admitted to the psychiatric unit were less likely to receive diagnoses of organic brain syndrome or profound mental retardation than nonmaltreated multihandicapped counterparts on the same unit. Moreover, data indicated that less severely impaired patients were more likely to be maltreated than were the more severely impaired. Particularly striking was the severity of maltreatment in this multihandicapped sample and the relatively high percentage (40%) of sexually abused patients who were assaulted by multiple perpetrators.

Psychometric properties and social correlates of assertion measures in chronic alcoholics.

Assertion is a major focus of many social skills interventions for alcoholics. The assessment of assertion often relies on self-report measures. However, few psychometric data are available on the most frequently used instruments. This study determined the internal characteristics and structure of two commonly employed measures of assertion: the Wolpe-Lazarus Assertion Inventory and the Callner-Ross Assertion Inventory. In addition, the relationship between responses on these devices and demographic variables, extent of substance abuse, and level of social functioning were examined. Results indicated that both inventories exhibit adequate internal consistency and test-retest reliability. Factor structures were relatively simple and represented general assertion situations. Results are discussed in terms of the need for further refinement of these instruments.