Moderators and Predictors of Response After 36 Weeks of Treatment in the Treatment for Adolescents with Depression Study (TADS).

This study investigated pretreatment variables associated with depression severity in adolescents following maintenance treatment for major depressive disorder (MDD). Data was derived from the Treatment for Adolescents with Depression Study (TADS). Participants received one of three treatments: cognitive behavioral therapy (CBT), fluoxetine (FLX), or combined CBT and fluoxetine (COMB). Participants received 12 weeks of acute treatment, 6 weeks of consolidation treatment, and 18 weeks of maintenance treatment (N = 327, M age = 14.62 yrs). Outcome was measured by the Children's Depression Rating Scale-Revised. Results showed adolescents with shorter depressive episodes, better global functioning, less suicidal ideation, better health/social functioning, and greater expectancy of positive treatment response were more likely to have lower depression severity following 36 weeks of treatment, regardless of modality. Adolescents with lower initial depression demonstrated lower depression severity if treated with CBT. FLX was more effective in reducing depression severity in adolescents with severe baseline depression than for those with mild or moderate depression. Adolescents with higher family incomes were more likely to have lower depression severity if they received CBT only. In conclusion, adolescents with shorter depressive episodes, better health, social, and global functioning, less suicidal ideation, and greater expectancy for treatment at baseline respond equally well to CBT, fluoxetine, and combined treatment. Adolescents who are more severely depressed at baseline may have a better treatment response if they are treated with FLX; whereas adolescents of higher income are more likely to have a better response if they receive CBT only.

Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory?

Overlap between depression scale item content and medical symptoms may exaggerate depression estimates for patients with multiple sclerosis (MS). We reconsider Mohr and co-workers' (1997) recommendation to omit Beck Depression Inventory (BDI) items assessing work ability (item 15), fatigue (17), and health concerns (20) for MS patients. Subjects were medical patients with either MS (n = 105) or a medical disorder for which the BDI is empirically supported [diabetes mellitus (DM), n = 71; chronic pain (CP), n = 80], psychiatric patients with depressive disorder (MDD; n = 37), and healthy controls (HC; n = 80). Relative scores for the eight "somatic" BDI items were analyzed by multivariate analysis of variance with demographic variables and BDI total as covariates. The only significant difference was MS > HC (item 15). On raw scores, MS patients exceeded HCs on items 15 and 21 (sexual disinterest), but this was attributable to the low HC item endorsement. There were no other differences on somatic items or item-total correlations. Scale consistency was good across groups, regardless of item omission. Somatic items were unassociated with major MS parameters. We thus encourage continued application of the full BDI for assessing depressive symptoms in patients with MS.

The third factor of the WISC-III: it's (probably) not freedom from distractibility.

OBJECTIVE: This study examined the ecological validity, construct validity, and diagnostic utility of the third factor of the WISC-III, heuristically labeled "Freedom From Distractibility" (FFD). METHOD: A sample of 200 children, aged 6 to 11 years, with attention-deficit hyperactivity disorder (ADHD) completed the WISC-III, the Wide Range Achievement Test-Revised, and the Test of Variables of Attention. Objective parent and teacher report measures of attention and hyperactivity were completed. RESULTS: Mean FFD scores were significantly lower than other WISC-III factor scores. The diagnostic utility of FFD is limited, however, as the majority of these children did not show a significant relative weakness on this index. Correlational analyses failed to support the concurrent, ecological, or construct validity of the FFD. FFD scores were not correlated with a measure of sustained visual attention. Findings suggest that among children with ADHD, a low FFD score may be associated with the presence of a learning disability or poor academic performance. This finding was maintained after level of general intelligence was statistically controlled. CONCLUSIONS: Clinicians and researchers should not view FFD as a reliable or valid index of attention or as a diagnostic screening measure for identifying children with ADHD.

Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis.

OBJECTIVE: Outcome studies support the effectiveness of cognitive-behavioral approaches for treating depression among adults. The effectiveness of these approaches for adolescents, however, has received less empirical attention. This article critically reviews the literature on cognitive-behavioral therapy with depressed and dysphoric adolescents. METHOD: A meta-analysis was conducted to assess the effectiveness of these approaches and the stability of therapeutic gains. RESULTS: Fourteen posttreatment-control comparisons and 10 follow-up-control comparisons resulted from six studies containing 217 subjects. The overall effect size posttreatment was -1.02, whereas the overall effect size at follow-up was -0.61. The effect sizes in both of these analyses were homogeneous and were supported by Fail-Safe-N calculations. CONCLUSION: Results suggest the short- and long-term effectiveness of cognitive-behavioral approaches for treating depressive symptoms with this population.

Psychometric characteristics of the Wender Utah Rating Scale (WURS): reliability and factor structure for men and women.

The goals of this study were to examine the factor structure of the Wender Utah Rating Scale (WURS), to evaluate potential gender differences in factor composition, and to assess the reliability of the scale. The WURS was completed by 310 fathers and 305 mothers of children referred for evaluation of Attention-Deficit Hyperactivity Disorder (ADHD). For males, a five-factor solution (Conduct Problems, Learning Problems, Stress Intolerance, Attention Problems, Poor Social Skills/Awkward) accounted for 72 percent of the variance. There was also a five-factor solution for females (Dysphoria, Impulsive/Conduct, Learning Problems, Attention and Organizational Problems, Unpopular) which accounted for 71 percent of the variance. Symptoms of inattention and impulsivity loaded on separate factors for both men and for women. Test-retest reliability was examined with a different sample of 57 adults who completed the WURS on two separate occasions, 1 month apart. The WURS demonstrated satisfactory internal consistency and temporal stability, and it may be a useful tool for the study of ADHD in adults.