Arthur L. Robin

Family Therapy versus Individual Therapy for Adolescent Females with Anorexia Nervosa

Behavioral family systems therapy (BFST) was compared with ego-oriented individual therapy (EOIT) in a controlled, random-assignment investigation involving 22 young adolescents with anorexia nervosa. Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen. BFST emphasized parental control over eating and weight gain, coupled with cognitive restructuring and problem-solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight into the emotional blocks to eating. BFST produced greater change on body-mass index than did EOIT, but both treatments produced comparable improvements on eating attitudes, body shape dissatisfaction, interoceptive awareness, depression/internalizing psychopathology, and eating-related family conflict. The implications of these results for the clinician who treats adolescents with anorexia nervosa are discussed. J Dev Behav Pediatr 15:111–116, 1994. Index terms: anorexia nervosa, adolescents, family therapy, individual therapy.

A controlled evaluation of problem-solving communication training with parent-adolescent conflict

Thirty-three families experiencing parent-adolescent conflict received problem-solving communication training, alternative family therapy, or a wait-list condition. Problem-solving communication training consisted of training in skills for negotiating solutions to specific disputes, remediation of negative communication patterns, cognitive restructuring of inappropriate attitudes, and practive in applying negotiation-communication skills at home. Alternative family therapy consisted of a heterogeneous blend of dynamic, family systems, and electic family therapy practiced at the clinic where the study took place. Both treatments resulted in significant reductions in self-reported disputes and conflictual communication at home; however, only problem-solving communication training resulted in significant improvements in problem-solving communication behavior objectively coded during family discussions. Most of the significant treatment effects were maintained at a 10-week follow-up. The results support the effectiveness of problem-solving communication training in ameliorating parent-adolescent conflict.

Treatment of eating disorders in children and adolescents

Anorexia nervosa and bulimia nervosa are expressed differently in children and adolescents than in adults. Consequently, diagnostic procedures and multidisciplinary treatments need to be tailored to the unique developmental, medical, nutritional, and psychological needs of children and adolescents with eating disorders. This paper reviews current research outlining the differences between child, adolescent, and adult eating disorders. Research is then reviewed concerning the effectiveness of hospitalization, partial hospitalization, individual dynamic therapy, cognitive-behavioral therapy, interpersonal therapy, family therapy, and medication for treating anorexia nervosa, bulimia nervosa, and related eating disorders in children and adolescents. Specific recommendations are made for practitioners to tailor these treatments to their eating-disordered child and adolescent patients, following a stepped-care, decision-tree model of intervention that takes into account the effectiveness, cost, and intrusiveness of the interventions.

Family versus individual therapy for anorexia: Impact on family conflict

This study evaluated the impact on family relations of behavioral family systems therapy (BFST) versus ego-oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. Twenty-two adolescents meeting DSM-III-R anorexia nervosa criteria were randomly assigned to receive approximately 16 months of either BFST or EOIT along with a common medical and dietary regimen. BFST emphasized parental control over eating, cognitive restructuring, and problem-solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight. Measures including body mass index, self-reported general and eating-related conflict, and observed general and eating-related communication. Both treatments produced significant reductions in negative communication and parent-adolescent conflict, with some differences between condition and between eating and non-eating related measures; the improvements in eating-related conflict were maintained at a 1-year follow-up. The study demonstrated that structured therapies for adolescent anorexia do impact family relations, even when the family is never seen as a unit during the therapy.

Problem-Solving Communication Training: A Behavioral Approach to the Treatment of Parent-Adolescent Conflict.

Abstract A short-term behaviorally-oriented treatment program for parent-adolescent conflict is described. The problem-solving communication training program has been designed to teach family members: 1) effective skills for seeking independence; 2) methods of communicating without antagonizing and alienating each other; 3) methods for resolving specific disputed issues; 4) ways of identifying, challenging and restructuring inappropriate attitudes; and 5) methods for relating in an adult-adult manner rather than an adult-child manner. The general content of the treatment program is described, procedures for treatment are presented and an illustrative case study is reviewed.

Validation of a measure for adolescent self-report of attention deficit disorder symptoms

The internal consistency, criterion-related, and concurrent validity of the ADD/H Adolescent Self-Report Scale was evaluated using 150 adolescent males ages 12 to 17 years; 103 cases were diagnosed with attention-deficit hyperactivity disorder (ADHD) and 47 with no known psychiatric condition. Participants completed the ADD/H Adolescent Self-Report Scale; their mothers completed the Conners Parent Questionnaire and Child Behavior Checklist. For the ADD/H Adolescent Self-Report Scale, Cronbachs α coefficients ranged from .81 to .91. Criterion-related validity was established when it was found that ADHD adolescents reported significantly more problems than controls on all 11 scales. Concurrent validity was established through the finding of moderately strong correlations between comparable scales of the adolescent and parent measures.

Conceptualizing, Assessing, and Treating Parent-Adolescent Conflict

Parent-adolescent conflict is a universal phenomenon which transcends socioeconomic class, ethnic groups, family constellations, formal psychiatric diagnoses, or any other common schemas for classifying families or individuals within families. As used here, the term refers to predominantly verbal arguments between teenagers and their parents concerning a variety of specific issues such as curfew, chores, peers, and school. The arguments may be isolated disagreements or continual bursts of negative interaction and may occur either in the absence of other behavior disorders or as part of behavior problems such as the attention deficit disorder, conduct disorders, or affective disorders.

A cluster analysis of personality style in adults with ADHD.

Objective: The purpose of this study was to use hierarchical linear cluster analysis to examine the normative personality styles of adults with ADHD. Method: A total of 311 adults with ADHD completed the Millon Index of Personality Styles, which consists of 24 scales assessing motivating aims, cognitive modes, and interpersonal behaviors. Results: The sample was randomly divided into half, and independent hierarchical linear cluster analyses were performed on each half to identify replicable clusters. A three-cluster solution was selected, and two of the clusters were replicated across the independent analyses. Participants in Cluster 1 manifested more polarized, negative motivating aims, cognitive modes, and interpersonal behaviors than participants in Cluster two. Conclusion: Hierarchical linear cluster analyses identified two very different personality styles in a sample of adults with ADHD, with implications for clinicians and future research. (J. of Att. Dis. 2008; 12(3) 254-263)

An approach to parent training for high school students

Abstract The present study was an evaluation of the effectiveness of a combined behavioral-reflective parent-training program with high school seniors. Twenty-four high school seniors were randomly assigned to either a nineweek parent-training course or a waiting list control group. Lectures, films, class discussions, role-playing exercises and examinations were used to teach concepts of behavioral and reflective child rearing. Analysis of achievement tests and written and role-played analogue assessment measures indicated that the parent-training course produced significant increments in behavioral and reflective parenting skills. The results were discussed in the context of teenagers developmental readiness to cope with the tasks of parenthood.

Family Therapy with Eating-Disordered Adolescents

Eating disorders represent potentially life-threatening conditions that impede physical, emotional, and behavioral growth and development. The prognosis is positive if an adolescent’s eating disorder is treated soon after its onset; otherwise, the disorder may become a chronic condition by adulthood, with devastating and sometimes irreversible medical, behavioral, and emotional consequences (Lask & Bryant-Waugh, 1993).