Outcomes associated with clinical profiles of children in psychiatric crisis enrolled in intensive, in-home interventions.

Little is known about the characteristics of children and youth presenting at emergency settings in psychiatric crisis, and virtually nothing is known about their outcomes. The purpose of this study is to describe the clinical profiles of 238 children presenting at two psychiatric emergency settings and enrolled in a randomized controlled trial of three intensive in-home interventions. A second purpose is to examine child mental health outcomes, based on clinical profile and to suggest the utility of using a clinical-profiles approach.

Effectiveness of screening instruments in detecting substance use disorders among prisoners.

This study examined the effectiveness of several screening instruments in detecting substance use disorders among prison inmates. A sample of 400 male inmates were administered eight different substance abuse screening instruments and the Structured Clinical Interview for DSM-IV (SCID-IV), Version 2.0, Substance Abuse Disorders module. The latter was used as a diagnostic criterion measure to determine the presence of substance use disorders. Based on positive predictive value, sensitivity, and overall accuracy, the Texas Christian University Drug Screen, the Simple Screening Instrument, and a combined instrument-Alcohol Dependence Scale/Addiction Severity Index-Drug Use section were found to be the most effective in identifying substance abuse and dependence disorders.

Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates.

The study examined the 30-day and lifetime prevalence of DSM-IV alcohol and drug disorders among state prison inmates. A sample of 400 inmates consecutively admitted to a state prison reception center were assessed for alcohol and drug disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Test-retest reliabilities were calculated for the SCID-IV. Lifetime substance abuse or dependence disorders were detected among 74% of inmates, including over half who were dependent on alcohol or drugs. For the 30 days prior to incarceration, over half of the sample were diagnosed as having substance abuse or dependence disorders, including 46% who were dependent on alcohol or drugs. Black inmates were significantly less likely to be diagnosed as alcohol dependent than whites or Hispanics. The high rates of substance use disorders are consistent with previous findings from other studies conducted in correctional settings and reflect the need to expand treatment capacity in prisons.

Co-occurring addictive and mental disorders among adolescents: prevalence research and future directions.

Recent epidemiological research documenting the pervasive co-occurrence of addictive and mental disorders has been concerned primarily with adults. This paper proposes the need for similar studies of adolescents, considers the special problems inherent in the assessment of co-occurrence in this age group, reviews evidence suggesting that the prevalence of co-occurring disorders in adolescents parallels that documented for adults, and delineates future research strategies.

Five methods for computing significant individual client change and improvement rates: support for an individual growth curve approach.

Interest has been renewed in methods for determining individual client change. Currently, there are at least 4 pretreatment-posttreatment (pre-post) difference score methods. A 5th method, based on a random effects model and multiwave data, represents a growth curve approach and was hypothesized to be more sensitive to detecting significant (p < .05) change than the pre-post methods. The change rates produced by the 5 methods were compared in a sample of 73 older outpatients with 3 to 5 assessments per client on a measure of well-being (H. J. Dupuy, 1977). Results indicated that the growth curve approach improvement rate was the highest (68.5%). The growth curve and the Edwards-Nunnally (63.0%) methods produced significantly (p < .05) higher improvement rates than the other 3 methods, with 1 exception.

Alcohol expectancies among adolescents with conduct disorder: prediction and mediation of drinking.

Among adolescents with conduct disorder, alcohol expectancies were examined for both predictive utility and mediation of other predictors of alcohol use (i.e., delinquency, family history, demographic and psychopathology variables). Data were collected from 260 adolescents with conduct disorder 11-18 years of age, who had been in either mental health residential facilities or community-based special education programs for adolescents with serious emotional disturbances. Zero-order correlations and structural path models assessed relationships between expectancies, alcohol use, and other predictors of alcohol use. Results indicated: (a) expectancies of enhanced social and cognitive behavior were significant (p < .05) univariate predictors of drinking, (b) among all of the selected predictors, expectancies of enhanced social behavior (i.e., Subscale 2 of the Alcohol Expectancy Questionnaire--Adolescent Form; AEQ-A) had the strongest association with alcohol use (r = .54) and mediated between 31% to 44% of the drinking variance associated with other significant predictors (p < .01). Results were discussed as supporting similar expectancy-drinking relationships among CD and nonclinical youth.

Expectancy for social facilitation from drinking: the divergent paths of high-expectancy and low-expectancy adolescents.

Using a 3-wave longitudinal design, adolescents were studied over a 2-year period during which many first began to drink. Covariance structure modeling showed that teens' expectancy for social facilitation from alcohol and their drinking experience influenced each other in a reciprocal, positive feedback fashion: the greater the expectancy endorsement, the higher subsequent drinking levels, and the higher the drinking levels, the greater the subsequent expectancy endorsement. This model fit the data quite well; comparison models, in which expectancy (or drinking) had no independent influence on future drinking (or expectancy), showed significantly poorer fit than the present model. Initial nondrinkers' social expectancy predicted individual differences in the rate of drinking increase over the 2 years. Results bolster the hypothesis that expectancy actively influences drinking and point to the importance of expectancy-based intervention efforts.

Dentist's reassuring touch: effects on children's behavior.

Physical contact with patients by health care providers has been found to benefit the patients by reducing their fearful or avoidant reactions. This study tested whether a reassuring touch could be used during a routine pediatric dental examination to reduce children's anxiety and improve their behavior. Thirty-eight children between 3.5 and 10 years of age were randomly assigned to one of two experimental conditions. Children assigned to the touch condition were patted on the upper arm or shoulder on two separate occasions by the dentist during the examination while simultaneously receiving verbal reassurance and descriptions of the upcoming procedures. Children in the no-touch control condition received only the reassuring verbal descriptions without contact. Results indicated that touched children between the ages of 7 and 10 years (but not children aged 3.5 to 7 years) displayed less fidgeting behavior than their no-touch counterparts (P < 0.05). Post-treatment, children who were touched tended to report greater pleasure (P < 0.06) but less dominance (P < 0.10) than children not touched.

Family functioning and psychopathology among adolescents with severe emotional disturbances.

Family psychosocial functioning and its relation to psychopathology among adolescents with severe emotional disturbances (SED) was assessed. Subjects were 353 adolescents with SED, ages 12-18, and their parents. During a semi-structured interview, adolescents were administered Family Adaptability and Cohesion Evaluation Scale (FACES-III), Diagnostic Interview Schedule for Children-Child Version (DISC-C), and the Self-Derogation Scale. Parents were administered FACES-IIII and the Child Behavior Checklist (CBCL) in a phone interview. Results indicated that on the FACES-IIII cohesion dimension, both parents and adolescents perceived their family relations as more disengaged and less connected than did normative families (p less than .001). In contrast, only parent FACES-IIII adaptability scores were significantly more extreme than a normative sample (p less than .01). Additionally, both parent and adolescent cohesion scores were significantly correlated with adolescent psychopathology measures: DISC-C conduct disorder (p less than .01), depression (p less than .05), alcohol/marijuana (p less than .01), and CBCL externalizing symptoms (p less than .01). These relationships did not deviate from linearity.

Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbances.

Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.

Dentists' voice control: effects on children's disruptive and affective behavior.

Voice control, a punishment technique based on loud commands, has been used widely in pediatric dentistry. This study examined whether (a) loudness is a necessary component of the technique, (b) voice control actually reduces children's disruptive behavior, and (c) after treatment, children's negative affect increases. Subjects were forty 3 1/2- to 7-year-olds who posed potential behavior problems and who were scheduled for cavity restoration. Children were assigned randomly to either loud- or normal-voice groups. Children who were assigned to either group but who were not disruptive formed a nonexperimental control group. Prior to and after treatment, children reported their feelings using the Self-Assessment Mannequin. Disruptive behavior was scored using the Behavior Profile Rating Scale. Results indicated that, following loud, but not normal voice commands, children reduced their disruptive behavior (p less than .004) and self-reported lower arousal (p less than .09) and greater pleasure (p less than .10). Theoretical and practical implications of these findings are discussed.

Pretreatment modeling. A technique for reducing children's fear in the dental operatory.

Research on modeling indicates that this technique offers dentists a means of reducing fear in child patients of all ages. As a preventive measure used with children who have had no prior exposure to dental treatment, it can be particularly efficacious. Based on the assumption that much of adult dental avoidance is based on dental fears acquired in childhood treatment, the reduction of children's dental fear would have a positive effect on the individual's tendency to seek out dental health care throughout his or her lifespan. For the dentist, there are also short- and long-term benefits. Dental management of the child is prerequisite to providing good dental care. Pedodontics as a specialty recognizes behavioral management of the child cannot be separated from the quality of the dentist's work. Fear has been identified as an important factor in disruptive behavior of school age children in the dental office. Practicing dentists consider the fearful, disruptive child to be among the most troublesome of problems in their clinical work. The child must cooperate or at least passively comply with the dentist's procedures in order to have the technical work completed. By reducing disruptive patient behavior (crying, screaming children whose peripheral and gross motor movements often make direct contact with the dentist or his equipment) the most unpalatable aspect of pediatric dentistry is minimized. Further, the actual time for treatment becomes shorter rather than longer. Although modeling is not restricted to videotape media, the emergence of current videotape technology provides the practitioner with the means for incorporating patient viewing of prerecorded modeling tapes as part of the usual waiting period. Such a procedure would mean that in the long run, the dentist will spend more time doing dentistry and less in behavioral management tasks.

Mother-child patterns of coping with anticipatory medical stress.

Maternal influences on children's fear and coping behaviors during a medical examination were studied in a pediatric outpatient clinic using the Dyadic Prestressor Interaction Scale (DPIS) to measure anticipatory reactions just prior to contact with the physician. Analysis of 50 mother-child dyads, including children from 4 to 10 years of age, revealed that the behaviors emitted by mother and child are likely to influence the child's ability to tolerate the medical experience. Maternal use of distraction and low rates of ignoring were associated with lower child distress and increased prosocial behaviors. Children's active exploration of the situation was more likely to occur when mothers provided their children with information, and was less likely when mothers reassured their children. Maternal reassurance of children and overt maternal agitation were associated with more maladaptive child responses. Age trends were also found in interactive patterns. Younger children were more likely to receive reassurance from mothers when they showed attachment. There was a stronger association between mother's information giving and child's exploring for children under 5 years, 9 months of age. Results supported the usefulness of the DPIS for investigation of child management techniques in this situation. Theoretical extension to attachment and stranger-approach situations was made. Suggestions for future studies to clarify the reciprocity of interactions or to determine causal direction between mother and child behaviors, as well as to evaluate the specificity or generality of these findings, were provided.