Beck's cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability.

AIM: This study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID. METHODS: The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression. RESULTS: The cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups. CONCLUSION: The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. WHAT THIS PAPER ADDS?: Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.

A Pilot Study Evaluating "Dojo," a Videogame Intervention for Youths with Externalizing and Anxiety Problems.

OBJECTIVE: Externalizing problems, which are the main reason for youth referrals to mental health agencies, are highly persistent and predict a range of negative outcomes. Youths with externalizing problems are also frequently comorbid with anxiety. Among the most widely recognized evidence-based treatments is cognitive behavioral therapy (CBT). Although CBT principles seem to be sound, effect sizes remain moderate, suggesting improvements could be made to this conventional treatment approach. The main premise of the current pilot study is to investigate the feasibility of implementing a videogame intervention ("Dojo" [Gamedesk, Los Angeles, CA]) that incorporates CBT principles and aims to address the limitations of conventional CBT delivery models, with the ultimate goal of improving outcomes for this difficult-to-treat population. MATERIALS AND METHODS: "Dojo" is an emotion management game that helps youths to recognize and control their physiological and emotional arousal. We explored the implementation and user experience of "Dojo" in a sample of eight adolescents in residential treatment for both externalizing and anxiety problems. RESULTS: Participants attended all sessions without complaints. They evaluated "Dojo" very positively and exhibited high compliance during the training sessions. We encountered some problems with session scheduling and obtaining mentor reports. Quantitative data show the predicted decrease in three out of four measurements. CONCLUSIONS: The smooth implementation, high user satisfaction, high self-reported compliance during training sessions, and initial outcome results all indicate the high potential "Dojo" holds as an innovative intervention. If additional rigorously designed randomized controlled trials prove to be successful, "Dojo" can be a cost-effective way to engage high-risk youths in effective intervention.

Assessment of psychosocial problems in children with type 1 diabetes and their families: the added value of using standardised questionnaires in addition to clinical estimations of nurses and paediatricians.

AIMS AND OBJECTIVES: To investigate the assessment of psychosocial problems in children with type 1 diabetes by means of clinical estimations made by nurses and paediatricians and by using standardised questionnaires. BACKGROUND: Although children with type 1 diabetes and their parents show increased risk for psychosocial problems, standardised assessment of these problems lacks in diabetes care. DESIGN: By comparing these different modes of assessment, using a cross-sectional design, information about the additional value of using standardised questionnaires is provided. METHODS: Participants were 110 children with type 1 diabetes (aged 4-16), their parents, and healthcare professionals. Children filled out the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Inventory, Diabetes Module. Parents filled out the Strengths and Difficulties Questionnaire parent-report and the Parenting Stress Index. Independently, nurses and paediatricians filled out a short questionnaire, which assessed their clinical estimations of the children's psychosocial problems and quality of life, and parents' levels of parenting stress. Reports of children and parents were compared to clinical estimations. RESULTS: Children in our sample showed more psychosocial problems and lower health-related quality of life than their healthy peers. In approximately half of the children, dichotomous estimations by healthcare professionals and dichotomised reports by patients and parents were in agreement. In 10% of the children, no psychosocial problems were present according to professionals' estimations, although patients and parents-reported psychosocial problems. In 40%, psychosocial problems were present according to professionals' estimations, although parents and patients did not report psychosocial problems. CONCLUSION: Children with type 1 diabetes show more psychosocial problems than healthy children. Professionals seem to tend towards overestimating psychosocial problems. RELEVANCE TO CLINICAL PRACTICE: Extending the assessment of psychosocial problems with routine screening on patient-reported outcomes, using validated questionnaires, could be of additional value in tailoring care to the needs of the individual child and parents.

Psychological functioning of siblings in families of children with chronic health conditions: a meta-analysis.

OBJECTIVE: The aim of this meta-analysis was to provide an up-to-date review of the literature to enhance our understanding of how chronic health conditions (CHCs) affect siblings, both positively and negatively. METHODS: PsycINFO and Medline were systematically searched. Inclusion criteria were as follows: (a) peer-reviewed, empirical research report; (b) sample n ≥ 10; and (c) reports statistics on siblings' internalizing problems, externalizing problems, and/or positive self-attributes. RESULTS: Overall, there was a significant small negative effect of CHCs on siblings (d(+) = -.10). Siblings of children with CHCs had more internalizing problems (d(+) = .17), more externalizing problems (d(+) = .08), and less positive self-attributes (d(+) = -.09) than comparisons. Older siblings and siblings of children with life-threatening and/or highly intrusive CHCs were more at risk for psychological problems. CONCLUSIONS: This study identified several mechanisms through which CHCs affect siblings. Future research should focus on parent-child dynamics and the longitudinal development of positive self-attributes and internalizing problems as well as on identifying what works in services for siblings of children with CHCs.

PMTS and stress response sequences in parents of children with spina bifida.

OBJECTIVE: To test the presence and progress of Pediatric Medical Traumatic Stress (PMTS) symptoms in parents of children with spina bifida (SB). METHODS: Parents of 23 newborns with SB were interviewed prospectively and parents of 58 school-aged children with SB were interviewed retrospectively. PMTS symptoms were assessed with 17 DSM-IV criteria for the clusters Intrusion, Avoidance, and Increased Arousal. RESULTS: Within 3 months after the SB diagnosis, 75% of the parents met diagnostic criteria for symptoms of Intrusion and Increased Arousal, but not of Avoidance. In parents of school-aged children with SB, PMTS symptoms had declined in the first 4 years of the child's life and stabilized during the school years. Approximately 30% of the mothers and 20% of the fathers still met diagnostic criteria for Intrusion, Avoidance and Increased Arousal. In mothers of children with open SB, symptoms of Intrusion and Increased Arousal had decreased more slowly than in mothers of children with closed SB. CONCLUSIONS: An SB diagnosis initially provokes traumatic stress symptoms in three-quarters of the parents; however, in most of them, these symptoms diminish during the first 4 years of the child's life. In a minority of the parents, severe stress symptoms persist beyond middle childhood. Professional psychological help may need to be offered to this selective group of parents whose levels of stress do not decline after the child's preschool years. Longitudinal research is needed to further investigate and confirm the trends that were found in parents' psychological adjustment to SB.

Parents' social adjustment in families of children with spina bifida: a theory-driven review.

OBJECTIVE: Five theoretical hypotheses about the impact of spina bifida (SB) on parents' social adjustment in the parent-child, the marital and the family-level relationship were tested. METHODS: PsycInfo, Medline and reference lists were searched. This yielded 27 eligible reports. Effect sizes (Hedges' d) were computed to estimate the impact of SB. RESULTS: Overall, the effects of SB were small to negligible on the affective dimensions of parents' relationships. The few effects that were found tended to be positive. The most important negative effects of SB were found in the parent-child relationship (parenting stress and overprotection). CONCLUSIONS: Support was found for the resilience-disruption hypothesis, the role-division hypothesis and the miscarried-helping hypothesis, but not for the marital-disruption hypothesis or the marginality hypothesis.

Parents' psychological adjustment in families of children with spina bifida: a meta-analysis.

BACKGROUND: Spina Bifida (SB) is the second most common birth defect worldwide. Since the chances of survival in children with severe SB-forms have increased, medical care has shifted its emphasis from life-saving interventions to fostering the quality of life for these children and their families. Little is known, however, about the impact of SB on family adjustment. Reviewers have struggled to synthesize the few contradictory studies available. In this systematic review a new attempt was made to summarize the findings by using meta-analysis and by delimiting the scope of review to one concept of family adjustment: Parents' psychological adjustment. The questions addressed were: (a) do parents of children with SB have more psychological distress than controls? (b) do mothers and fathers differ? and (c) which factors correlate with variations in psychological adjustment? METHODS: PsycInfo, Medline, and reference lists were scanned. Thirty-three relevant studies were identified of which 15 were eligible for meta-analysis. RESULTS: SB had a negative medium-large effect on parents' psychological adjustment. The effect was more heterogeneous for mothers than for fathers. In the reviewed studies child factors (age, conduct problems, emotional problems, and mental retardation), parent factors (SES, hope, appraised stress, coping, and parenting competence), family factors (family income, partner relationship, and family climate), and environmental factors (social support) were found to be associated with variations in parents' psychological adjustment. CONCLUSION: Meta-analysis proved to be helpful in organizing studies. Clinical implications indicate a need to be especially alert to psychological suffering in mothers of children with SB. Future research should increase sample sizes through multi-center collaborations.