This case study demonstrates the use of a modified evidence-based treatment protocol for “Maya,” a 13-year-old girl who presented with a fear of sleeping alone, Autism Spectrum Disorder (ASD), and separation anxiety disorder (SAD). The... more
This case study demonstrates the use of a modified evidence-based treatment protocol for “Maya,” a 13-year-old girl who presented with a fear of sleeping alone, Autism Spectrum Disorder (ASD), and separation anxiety disorder (SAD). The treatment, which spanned across 36 sessions, consisted of skills acquisition and exposure, with modifications made to address Maya’s ASD symptoms and cognitive limitations. Modifications for treating comorbid anxiety and ASD are described, including the use of: forced-choice list for emotions and somatic cues of anxiety, concrete props for teaching skills, and a higher level of parent involvement than typical for adolescent clients being treated for anxiety. Based on in-office observations and parental reports of at-home behavior, Maya’s avoidance of sleeping alone decreased over time, and she was able to sleep alone by the end of treatment. This case demonstrates successful treatment of fear of sleeping alone in a child with co-occurring anxiety and ...
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aking it to the Streets: Advancing the Dissemina-tion of CBT’’ was the theme of the annual meeting ofthe Association for Behavioral and Cognitive Therapies(ABCT) held in Orlando, Florida in November 2008.ABCT is an interdisciplinary... more
aking it to the Streets: Advancing the Dissemina-tion of CBT’’ was the theme of the annual meeting ofthe Association for Behavioral and Cognitive Therapies(ABCT) held in Orlando, Florida in November 2008.ABCT is an interdisciplinary organization comprisingresearchers, clinicians, and trainees who are committedto development, implementation, and dissemination ofbehavioral, cognitive, and other evidence-based inter-ventions. Historically, the ABCTannual meetings havehad a preponderance of presentations focused on thetreatment of anxiety and depressive disorders, andthe 2008 meeting was no exception. Below are some ofthe highlights of this year’s convention.Treatments for childhood anxiety were evaluated inthe Child/Adolescent Anxiety Multimodal TreatmentStudy (CAMS), a multisite National Institute of MentalHealth (NIMH)-supported trial comparing the efficacyof cognitive-behavior therapy (CBT), sertraline, pillplacebo, and a combination of CBTand sertraline fortreating children and ado...
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Objective Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al.,... more
Objective Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al., 2017). Workshops, ongoing consultation, and feedback provided in person are effective, yet are rarely feasible for clinicians in the field (Fixsen, Blase, Duda, Naoom, & Van Dyke, 2010). The purpose of the present study was to conduct a preliminary assessment of an online tutorial combined with live remote coaching for training mental health professionals in behavioral parent training. Method Participants in this pretest-posttest open trial were 22 clinicians and graduate students (73% female) from around the United States. Results The web platform operated successfully, and clinicians found the training to be highly satisfactory. Compared to pre-training, participants demonstrated large improvements in knowledge about disruptive behavior and behavioral parent training and performed significantly better on demonstrations of skill in administering behavioral parent-training components. Conclusions An online course combined with live remote coaching is a promising methodology for significantly increasing the number of clinicians trained in evidence-based interventions for disruptive behavior in children. Next steps for evaluation and expansion of this training model are discussed.
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Maternal depression is a major public health concern, as children of depressed mothers have a substantially increased risk for psychiatric problems into adulthood. Low-income mothers have high rates of depression, yet few receive mental... more
Maternal depression is a major public health concern, as children of depressed mothers have a substantially increased risk for psychiatric problems into adulthood. Low-income mothers have high rates of depression, yet few receive mental health care. Barriers have been identified, but solutions have been based on what mental health professionals believe is helpful rather than mothers’ own perspectives, or require participation in an existing treatment. The purpose of our study was to learn what low-income, depressed mothers believe they need from mental health care to overcome barriers to mental health care. Twelve mothers with at least one child between the ages of 2 and 17 participated in individual interviews. Using qualitative grounded theory methodology, data were organized into six theoretical constructs. These included: (1) attitudes, expectations, and emotions impact the intention to enter treatment, (2) identifying as self-sufficient inhibits the intention to enter treatment, (3) providing knowledge, skills and environmental resources facilitate treatment entry, (4) habits and life circumstances that make treatment seem unimportant inhibit treatment entry, (5) balancing acceptance, change, and the therapeutic relationship facilitates treatment retention, and (6) sharing similarities with people involved in treatment often, but does not always facilitate treatment retention. A 3-step theory was developed regarding variables that influence mothers’ (a) intentions to enter treatment, (b) treatment entry, and (c) treatment retention. Offering what low-income, depressed mothers believe they need could better engage and retain them in mental health treatment.
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BackgroundWhile a large number of patients with eating disorders (EDs) engage in excessive exercise (EE), both for weight control and mood regulation, there has been minimal research evaluating the relationship between EE and demographic... more
BackgroundWhile a large number of patients with eating disorders (EDs) engage in excessive exercise (EE), both for weight control and mood regulation, there has been minimal research evaluating the relationship between EE and demographic and psychological factors, especially in adolescent patients.PurposeThe goals of this study were to identify the occurrence of EE compared to other ED behaviors and to develop a regression model examining psychological, behavioral and demographic predictors of EE among adolescents with EDs.MethodsDemographic and clinical information was determined for 217 adolescent patients in several levels of care (126 outpatient, 61 day program, 28 inpatient) with diagnoses of anorexia nervosa (AN) (24.9%), bulimia nervosa (BN) (25.8%), and eating disorder not otherwise specified (EDNOS) (49.3%). These patients presented to a large ED program and completed a series of questionnaires on admission to the program. Descriptive statistics, t-tests, chi-square analyse...
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The process of terminating cognitive-behavioral therapy (CBT) with families has been largely neglected in the literature, with the limited research focused on premature termination. This article describes the natural termination process... more
The process of terminating cognitive-behavioral therapy (CBT) with families has been largely neglected in the literature, with the limited research focused on premature termination. This article describes the natural termination process in CBT with children, adolescents, and their parents. Based on existing theories, we describe a cognitive-behavioral model for: (a) initiating and engaging in discussion of termination, (b) processing the termination of treatment and the therapeutic relationship, (c) key aspects of the termination process in the final session, and (d) the very end of the final session (saying goodbye). For each of the 4 components, we review relevant theories, provide clinical exchanges to demonstrate techniques, and provide related research support. (PsycINFO Database Record
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This chapter addresses the increasing community concern about student mental health and considers the role of the school psychologist in relation to this issue, both from a preventative and a treatment perspective. Intervention can be... more
This chapter addresses the increasing community concern about student mental health and considers the role of the school psychologist in relation to this issue, both from a preventative and a treatment perspective. Intervention can be important and relevant at an individual, selective and universal level. Prevalence figures reveal that many students in schools will experience severe difficulties. Understanding and supporting students with these problems and disorders are an important task. At the same time school communities are challenged to consider ways to enhance the positive well-being of young people and develop a prevention focus alongside the focus on individual treatment. The school psychologist has a valuable role in a school context to work with teaching staff and school leadership to build a foundation of well-being and positive mental health policy and practice. The school can be considered a universal and accessible agency for implementation of prevention and early intervention in mental health disorders, and the school psychologist is a key player in this approach.
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Depression in low-resource communities internationally is highly prevalent, disabling, and largely untreated. Recent clinical trials in developing countries demonstrated the effectiveness of psychosocial and pharmacological treatments of... more
Depression in low-resource communities internationally is highly prevalent, disabling, and largely untreated. Recent clinical trials in developing countries demonstrated the effectiveness of psychosocial and pharmacological treatments of depression. This ...
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The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents. A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine... more
The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents. A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine practice agreed to complete a survey by interview or self-report, including screening diagnoses and treatment history. Three groups were compared: major, subthreshold, and no depression. Nearly one-third had major (9%) or subthreshold depression (23%), and many in the depressed groups reported recent treatment (50% and 31%, respectively). Parents with any depression were significantly more likely than nondepressed parents to report interest in receiving help, endorse treatment obstacles, and report children's problems. High rates of personal and child problems, interest in treatment, and treatment obstacles among low-income, depressed parents highlight the need to develop acceptable mental health services for them and their children, even when parents do not meet full diagnostic criteria for depression.
Research Interests: Accessibility, Poverty, Mental Health, Depression, Treatment, and 19 morePublic Health, Adolescent, Family Practice, Humans, Child, Female, Male, Young Adult, Attitude, Social Environment, Socioeconomic Status, Middle Aged, Parents, Adult, Public health systems and services research, Ethnic Group, Psychiatric Services, Urban Population, and Psychiatric
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Research Interests: Treatment and Prevalence
Research Interests: Psychology, Parenting, Intergroup Conflict (Psychology), Family Psychology, Child Behavior, and 14 moreMarriage, Humans, Child, Female, Male, Structural Equation Model, Adult, Sex Factors, Behavior Problems, Reproducibility of Results, Chi Square Distribution, Psychological Models, Child Rearing, and Child preschool
The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents. A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine... more
The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents. A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine practice agreed to complete a survey by interview or self-report, including screening diagnoses and treatment history. Three groups were compared: major, subthreshold, and no depression. Nearly one-third had major (9%) or subthreshold depression (23%), and many in the depressed groups reported recent treatment (50% and 31%, respectively). Parents with any depression were significantly more likely than nondepressed parents to report interest in receiving help, endorse treatment obstacles, and report children's problems. High rates of personal and child problems, interest in treatment, and treatment obstacles among low-income, depressed parents highlight the need to develop acceptable mental health services for them and their children, even when parents do not meet full diagnostic criteria for depression.
Research Interests: Accessibility, Poverty, Mental Health, Depression, Treatment, and 19 morePublic Health, Adolescent, Family Practice, Humans, Child, Female, Male, Young Adult, Attitude, Social Environment, Socioeconomic Status, Middle Aged, Parents, Adult, Public health systems and services research, Ethnic Group, Psychiatric Services, Urban Population, and Psychiatric
Research Interests: Anxiety Disorders, Psychometrics, Personality Assessment, Adolescent, Fathers, and 16 moreHumans, Child, Personality Assessment Inventory, Anthropological Archaeology, New York City, Female, Male, Depressive Disorder, Mothers, Mental Disorders, Conduct Disorder, Risk factors, African Americans, European Continental Ancestry Group, Risk Factors, and The American
Research Interests: Psychology, Parenting, Intergroup Conflict (Psychology), Family Psychology, Child Behavior, and 14 moreMarriage, Humans, Child, Female, Male, Structural Equation Model, Adult, Sex Factors, Behavior Problems, Reproducibility of Results, Chi Square Distribution, Psychological Models, Child Rearing, and Child preschool
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Children of depressed and/or anxious parents are at increased risk for developing psychiatric disorders. Little research has focused on screening parents bringing their children for psychiatric evaluation, and few studies have included... more
Children of depressed and/or anxious parents are at increased risk for developing psychiatric disorders. Little research has focused on screening parents bringing their children for psychiatric evaluation, and few studies have included fathers or Hispanic children. This study had the following aims: 1) to identify current symptom rates in parents bringing their children for evaluation; and 2) to determine whether parental symptoms were associated with children's symptoms, diagnoses, and functioning.The sample included 801 mothers, 182 fathers, and 848 children (aged 6 through 17 years). The majority (55.66%) were Hispanic, who attended a child and adolescent psychiatric evaluation service. Parent and child symptoms were assessed via parental reports. Children's diagnoses and functioning were determined by clinicians. Multiple regression analyses were used to determine whether severity of parental symptoms was associated with clinical child variables adjusting for child and parent demographic variables.In all, 18.80% of mothers and 18.42% of fathers reported elevated internalizing symptoms. Maternal symptoms were significantly associated with problems in children's functioning and children's anxiety, depression, and oppositional/conduct diagnoses; but not attention-deficit/hyperactivity disorder. Adjusting for parental and child demographics had a reduction on the effect of maternal symptoms on child depression. Paternal symptoms and functioning were positively associated with children's diagnoses, but the associations were smaller and not significant. Both parents' symptoms were significantly associated with children's internalizing and externalizing symptoms. However, these significant effects were not moderated by marital status or child ethnicity.This study highlights the importance of screening parents when their children receive a psychiatric evaluation. The findings support the development of mental health services that address psychiatric needs of the entire family within one clinical setting.
Research Interests: Anxiety Disorders, Psychometrics, Personality Assessment, Adolescent, Fathers, and 16 moreHumans, Child, Personality Assessment Inventory, Anthropological Archaeology, New York City, Female, Male, Depressive Disorder, Mothers, Mental Disorders, Conduct Disorder, Risk factors, African Americans, European Continental Ancestry Group, Risk Factors, and The American
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Pediatric anxiety disorders are prevalent, chronic, and often lead to significant impaired functioning that impacts both short- and long-term outcomes for children and adolescents. Treatment options include pharmacotherapy and... more
Pediatric anxiety disorders are prevalent, chronic, and often lead to significant impaired functioning that impacts both short- and long-term outcomes for children and adolescents. Treatment options include pharmacotherapy and psychosocial interventions. This presentation will review treatment advances specifically for pharmacotherapy. Current research supports serotonin reuptake inhibitors as the medication class to be the first-line treatment option for pediatric anxiety disorders. Available evidence for the efficacy of other classes of medications will be reviewed, along with the available approaches to manage partial responders and nonresponders. The risks and benefits of pharmacotherapy will also be reviewed. In addition, recent research has shown the potential promise of novel agents that act upon other neural systems implicated in the development of pediatric anxiety disorders. Novel compounds that affect the glutamate system will be discussed.