Considering the clinical utility of performance-based measures of childhood anxiety.

Examines general issues regarding the clinical utility of performance-based measures and specifically considers the utility of performance measures relevant to childhood anxiety and fear. First, we discuss the limitations of questionnaire and interview measures of childhood anxiety and the ways in which performance-based measures may compensate for or augment the use of such measures. Second, we review the major groups of performance-based measures that are potentially relevant to childhood anxiety and discuss evidence regarding their reliability and validity. Third, in the context of a general discussion of the various ways in which an assessment procedure may have clinical utility, we discuss the extent to which the performance-based techniques reviewed possess utility. Although many of these measures show promise of one or more types of clinical utility, none currently possess sufficient documented utility to warrant their dissemination for clinical use. We conclude by recommending directions for future research to demonstrate and improve the utility of such measures.

Tripartite model of depression and anxiety in youth psychiatric inpatients: relations with diagnostic status and future symptoms.

Examined the relation of the depression aspect of the tripartite model of depression and anxiety to the diagnostic status and future symptoms of two samples that included 74 child and adolescent psychiatric inpatients, ages 7 to 17 years (M = 13.57, SD = 2.39), some with either internalizing or externalizing diagnoses. The tripartite model suggests that anhedonia (low positive affect, or PA) differentiates depression from other conditions, whereas generalized negative affect (NA) also characterizes depression but is not specific to it. In this study, differences among children in PA and NA were associated with depressive versus externalizing diagnostic status and with future symptoms of depression. Depressive disorder diagnoses were associated with the combination of low levels of PA and high levels of NA. Changes over time in depression, but not in anxiety, also were associated with the combination of low PA and high NA. Results provide support for the applicability, clinical utility, and extension of the tripartite model with children.

Mental health services in the county jail: a critical partnership?

This study was designed to provide a description of individuals incarcerated in a county jail and referred for mental health services. A standardized intake form was completed for 598 inmates who had contact with the mental health counselor. Analysis of the mental health status of inmates suggests that the presence of a counselor in the jail may serve an important function. Specifically, inmates referred to the counselor were not in acute distress. This suggests they may be better served by an on-site counselor rather than through the traditional method of being transported to the hospital emergency room or community mental health center for evaluation.

Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: results from confirmatory factor analyses.

Factor analytic studies of trauma victims' posttraumatic stress disorder (PTSD) have offered conflicting hypotheses about how to conceptualize PTSD into symptom categories. The present study used confirmatory factor analyses of self-reported PTSD symptomatology from 5,664 child and adolescent victims of Hurricane Hugo to compare 10 models of PTSD dimensionality. PTSD was best represented by a 2nd-order PTSD factor that manifests in 3 symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal). This model was cross-validated on 3 age groups (late childhood, early adolescence, and late adolescence), and results indicated factorial invariance across groups. PTSD symptoms varied in relative centrality to the underlying dimensions of PTSD, which differed in their relations with anxiety and degree of traumatic exposure. Implications for classification criteria and an empirically supported theory of PTSD are discussed.

Positive and negative affectivity in children: confirmatory factor analysis of a two-factor model and its relation to symptoms of anxiety and depression.

The positive affect (PA) and negative affect (NA) framework that is embodied in the tripartite model of anxiety and depression has proved useful with adult populations; however, there is as yet little investigation with children concerning either the measurement of PA and NA or the relation between PA and NA and levels of adjustment. A confirmatory factor analysis was used in this study to examine the structure of self-reported affect and its relation to depressive and anxious symptoms in school children (4th to 11th grade). Results supported a 2-factor orthogonal model that was invariant across age and sex. Support for the expected pattern of relations between NA and PA with symptoms of depression and anxiety was strong for the older sample (M = 14.2 years) but weaker for the younger sample (M = 10.3 years). Results also provide preliminary support for the reliability and validity of the Positive and Negative Affect Schedule for children.

Factors influencing placement recommendations for hospitalized individuals with chronic mental illness.

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.

Diagnostic efficacy of posttraumatic symptoms in children exposed to disaster.

Examined 5 conditional probability indices to determine the diagnostic efficacy of 48 symptoms associated with posttraumatic stress disorder (PTSD) in 5,687 children exposed to Hurricane Hugo, of whom 5.5% had a diagnosis of posttraumatic stress syndrome (PTSS). Moderate levels of sensitivity and high levels of specificity were obtained for most symptoms. Odds ratios more precisely demonstrated that some Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms of PTSD, especially when combined, were useful for identifying children with PTSS but that anxiety symptoms and some DSM symptoms of PTSD had poor diagnostic utility. Satisfying criteria for the DSM-III-R numbing/avoidance cluster and symptoms from the numbing/avoidance cluster had the highest diagnostic efficacy, suggesting that avoidance may be the hallmark of severe posttraumatic reactions. These results suggest which symptoms should be conceptualized as central versus peripheral to the disorder and which symptoms and symptom combinations clinicians should attend to most when diagnosing or screening PTSD in children.

Bidirectional relations of phonological sensitivity and prereading abilities: evidence from a preschool sample.

Children's phonological sensitivity is a strong predictor of the development of reading skills. Recent evidence indicates that phonological sensitivity and reading are reciprocally related. That is, phonological sensitivity facilitates the development of early reading and early reading facilitates the development of phonological sensitivity. Whereas evidence for this reciprocal relation has come from studies with school-age children, this study examined the relation between phonological sensitivity and letter knowledge in 97 middle-income 4- and 5-year-old children in a 1-year longitudinal study. Multiple regression analyses revealed that phonological sensitivity predicted growth in letter knowledge, and letter knowledge predicted growth in phonological sensitivity when controlling for children's age and oral language abilities. These results indicate that the reciprocal relation between reading and phonological sensitivity is present relatively early in the development of literacy skills, prior to the onset of formal reading instruction.

Child development and emergent literacy.

Emergent literacy consists of the skills, knowledge, and attitudes that are developmental precursors to reading and writing. This article offers a preliminary typology of children's emergent literacy skills, a review of the evidence that relates emergent literacy to reading, and a review of the evidence for linkage between children's emergent literacy environments and the development of emergent literacy skills. We propose that emergent literacy consists of at least two distinct domains: inside-out skills (e.g., phonological awareness, letter knowledge) and outside-in skills (e.g., language, conceptual knowledge). These different domains are not the product of the same experiences and appear to be influential at different points in time during reading acquisition. Whereas outside-in skills are associated with those aspects of children's literacy environments typically measured, little is known about the origins of inside-out skills. Evidence from interventions to enhance emergent literacy suggests that relatively intensive and multifaceted interventions are needed to improve reading achievement maximally. A number of successful preschool interventions for outside-in skills exist, and computer-based tasks designed to teach children inside-out skills seem promising. Future research directions include more sophisticated multidimensional examination of emergent literacy skills and environments, better integration with reading research, and longer-term evaluation of preschool interventions. Policy implications for emergent literacy intervention and reading education are discussed.

Empirically supported psychosocial interventions for children: an overview.

Discusses issues related to the identification of psychosocial interventions for children that have demonstrated efficacy. Recent debate concerning differences between clinical trials research and clinical practice is summarized, including the tradeoff between interpretability (internal validity) and generalizability (external validity) of outcome studies. This article serves as an introduction to the special issue containing articles that have as their focus the identification of empirically supported psychosocial interventions for children as part of a task force. The article provides an overview of the history, agenda, and methodology used by the task force to define and identify specific empirically supported interventions for children with specific disorders. Whereas a number of well-established or probably efficacious interventions are identified within the series, more work directed at closing the gap between research and practice is needed.

Anxiety and depression in children and adolescents: negative affectivity and the utility of self-reports.

Self-reported depression and anxiety were examined in 233 inpatient children diagnosed with either an anxiety disorder or a depressive disorder. Depressed children reported more problems related to a loss of interest and low motivation, and they had a more negative view of themselves. Anxious children reported more worry about the future, their well-being, and the reactions of others. The groups did not differ in the degree of depressed affect reported in terms of being sad, lethargic, bothered by things, or feeling alone and isolated. These findings suggest that a general negative affectivity component is common to both anxiety and depression disorders and measures. The results demonstrate that anxiety and depression in children have distinguishing features that can be measured by common self-report instruments, and the findings indicate that 1 factor that may distinguish between anxiety and depression in children is positive affectivity.

Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles.

OBJECTIVE: To determine the range and severity of post-traumatic stress disorder (PTSD) symptoms exhibited by children after exposure to a natural disaster. METHOD: Three months after Hurricane Hugo struck Berkeley County, South Carolina, 5,687 school-aged children were surveyed about their experiences and reactions related to the storm. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index. RESULTS: Significant variation in the prevalence of PTSD symptoms was found across race, gender, and age groups. Self-reported symptoms were used to derive a post-traumatic stress syndrome classification according to DSM-III-R guidelines for the diagnosis of PTSD. More than 5% of the sample reported sufficient symptoms to be classified as exhibiting this post-traumatic stress syndrome. Females and younger children were more likely to receive this classification. At the symptom level, females reported more symptoms associated with emotional processing and emotional reaction to the trauma. Males were more likely to report symptoms related to cognitive and behavioral factors. Younger children were more likely to report symptoms overall. CONCLUSIONS: Children exposed to a high magnitude natural disaster report sufficient symptoms to establish a DSM-III-R derived classification of a PTSD syndrome. Differences between gender, age, and race groups appear to be related to differential risk of exposure, reporting biases, as well as a differential risk for developing post-traumatic symptoms.

Children exposed to disaster: II. Risk factors for the development of post-traumatic symptomatology.

OBJECTIVE: To examine the influence of subject and exposure variables on the development of post-traumatic stress disorder (PTSD) symptoms and syndrome in children exposed to disaster. METHOD: Three months after Hurricane Hugo, 5,687 school-aged children were surveyed about their experiences and reactions to the hurricane. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index. RESULTS: The presence of PTSD symptoms was strongly related to children's reported severity of the hurricane, degree of home damage sustained, and continued displacement; however, children's level of trait anxiety and their reported emotional reactivity during the hurricane were more strongly related to the presence of PTSD symptoms than were the exposure factors. Different sets of risk factors appeared to differentially influence the development of the three DSM-III-R PTSD symptom clusters. Little evidence for a differential effect of the risk factors between females and males and younger and older children was found. CONCLUSIONS: Level of trait anxiety appears to be the single strongest risk for the development of severe post-traumatic reactions. The higher rate of post-traumatic symptoms in females and younger children in combination with the absence of differential reaction to the risk factors suggests that females and younger children are more likely to develop posttraumatic reactions following a disaster.

The continuity of babble and speech in children with specific expressive language delay.

A natural language sample of babble and words was obtained for 37 two-year-olds with severe specific expressive language delay. Variables derived from this sample were used to predict individual differences in expressive language scores 5 months later. The rate of word use was positively related to language outcome, whereas rate of vowel babble was negatively related to outcome. Together, these two variables accounted for 41% of the variance in language outcome test scores. The addition of one nonlinguistic variable, a measure of behavior problems, allowed the prediction equation to account for over 50% of the variance in expressive language outcome. The single strongest correlate of language outcome was the proportion of consonantal to vowel babble. The degree of social responsiveness of babble and the length of babble were not related to later language scores. These findings indicate that for children with specific expressive language delay, vowel babble competes with expressive language, consonantal babble facilitates expressive language, and the length and social responsiveness of babble are independent of expressive language. The continuity between babble and speech is multidimensional and multidirectional.

Family history in developmental expressive language delay.

Familial aggregation of language deficits has been demonstrated in previous studies. However, researchers have typically failed to differentiate subgroups of language-impaired children. The present study used questionnaire data to assess the family history of speech, language, and school problems in a group of young children with developmental expressive language delay (ELD) and in a sample of normally developing children. In contrast to previous studies of language and speech problems, no strong familial component of ELD was found. Further, family history was not predictive of later language development in ELD children. These findings argue against genetic and familial causes of ELD and attest to the importance of differentiating subtypes of early language problems.