ABSTRACT
Little research has investigated psychotherapy attrition among child victims of violence, and no studies have evaluated the role of trauma characteristics (e.g., level of threat or injury, trauma frequency, perpetrator relationship, victim type, and trauma type). The current study evaluated premature psychotherapy termination with 134 child victims (ages 5-19 years) who were referred for exposure-based cognitive-behavioral therapy. Results indicated that premature treatment termination was associated with children who experienced (a) a single incident of trauma (compared to multiple), (b) neither life threat nor physical injury during the victimization, (c) and an incident that was perpetrated by an older child compared to a parental figure. Certain trauma characteristics may be important factors for identifying children at risk for terminating treatment prematurely.
Subject(s)
Child Abuse/psychology , Cognitive Behavioral Therapy/standards , Life Change Events , Patient Dropouts/psychology , Violence/psychology , Adolescent , Adult , Child , Child Abuse/therapy , Child, Preschool , Female , Humans , Male , Young AdultABSTRACT
The current study examined indices of trauma-related symptom severity as predictors of dropout from exposure-based cognitive behavioral therapy in a sample of 99 child and adolescent trauma victims. The investigation incorporated measures of symptom severity at two time points: pretreatment and just before termination. The results indicated that a model with symptom severity measured just before termination was significantly associated with the number of attended sessions; however, a model with the symptom-severity indices measured at pretreatment was nonsignificant. In addition, a significant main effect indicated that increased avoidance behavior measured just before termination was related to fewer treatment sessions. Further analyses also suggested that higher severity of intrusion and depression measured just before termination was correlated with fewer treatment sessions. The results support the idea that more immediate distress may be related to treatment dropout. Implications for the research and practice of exposure therapy for child trauma are discussed.
Subject(s)
Child Abuse/diagnosis , Child Abuse/therapy , Cognitive Behavioral Therapy/methods , Patient Dropouts/statistics & numerical data , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapy , Adolescent , Child , Child Abuse/psychology , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/psychology , Child Abuse, Sexual/therapy , Child, Preschool , Crime Victims/psychology , Female , Follow-Up Studies , Humans , Implosive Therapy/methods , Life Change Events , Male , Patient Dropouts/psychology , Personality Inventory , Probability , Severity of Illness Index , Stress Disorders, Post-Traumatic/psychology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The objective was to evaluate quality of life (QOL) in at-risk-for-overweight and overweight Mexican-American children after participating in 6 months of intensive weight management or self-help. RESEARCH METHODS AND PROCEDURES: Eighty sixth- and seventh-grade at-risk-for-overweight (BMI >or=85th to <95th percentile) and overweight (BMI >or=95th percentile) Mexican-American children were randomly assigned to either intensive instructor-led intervention (ILI) or self-help (SH). The ILI condition included daily participation for 12 weeks in a school-based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self-report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. RESULTS: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, -0.13 +/- 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. DISCUSSION: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican-American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.
Subject(s)
Mexican Americans , Obesity/prevention & control , Quality of Life , Weight Loss , Adolescent , Body Mass Index , Child , Child Nutrition Sciences , Disease Management , Female , Humans , Life Style , Male , Mexican Americans/ethnology , Obesity/ethnology , Obesity/therapy , Regression Analysis , Schools , Treatment OutcomeABSTRACT
Although researchers have begun to examine the issue of ethnic and cultural factors in childhood sexual abuse (CSA), relatively little has been done to look at possible ethnic and cultural differences in psychological symptoms related to CSA. This study investigated the relationship between ethnicity and symptom presentation among Hispanic, African American, and Caucasian sexually abused girls. The study examined the relationship between ethnicity and depression, ethnicity and post-trauma intrusive symptoms, and ethnicity and post-trauma avoidance symptoms. Results indicated that African American girls had significantly higher levels of post-trauma avoidance symptoms than Hispanic girls, but not Caucasian girls. No significant differences were found between ethnic groups for depression or intrusive symptoms.
Subject(s)
Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/ethnology , Child Behavior/ethnology , Cross-Cultural Comparison , Cultural Characteristics , Survivors/psychology , Adolescent , Black or African American/psychology , Child , Child Abuse, Sexual/psychology , Depression/ethnology , Female , Hispanic or Latino/psychology , Humans , Life Change Events , Stress Disorders, Post-Traumatic/ethnology , Surveys and Questionnaires , White People/psychologyABSTRACT
OBJECTIVES: To examine changes in isometric muscle strength at the elbow, knee, and ankle at 6 months and 1 year after selective dorsal rhizotomy (SDR) and to determine if SDR altered the frequency of muscle cocontraction. DESIGN: Prospective outcome study of a consecutive sample. SETTING: Children's hospital. PATIENTS: Ten children with spastic diplegia (7 independent and 3 dependent ambulators who used assistive devices) and 8 age-matched controls. INTERVENTIONS: SDR; physical and occupational therapy; elbow, knee, and ankle measured for flexion and extension strength during three 10-second isometric contractions for each muscle group; and monitored cocontraction measured via muscle electrodes. MAIN OUTCOME MEASURES: Absolute and normalized values of isometric strength; and alterations in the frequency of cocontraction at 6 months and 1 year postoperatively. RESULTS: Children with spastic diplegia showed significantly weaker knee extensors, ankle dorsiflexors, and ankle plantarflexors than age-matched controls. There were no significant differences in strength between the 2 groups in the elbow flexors, elbow extensors, and knee flexors. Isometric strength did not increase or decrease significantly after SDR. Cocontraction during knee extension was normalized after SDR, whereas cocontraction during ankle plantarflexion was unchanged by SDR in the majority of children. CONCLUSION: SDR did not result in a significant decrease in muscle strength in ambulatory children with spastic diplegia. The normalization of the electromyographic patterns at the knee and not the ankle after SDR lends support to the premise that in children with cerebral palsy cocontraction is multifaceted, representing a volitional strategy to enhance control, as well as a disorder of the mechanisms that govern patterns of muscle activity.
