Elizabeth A. Egan

Testing Communities That Care: The Rationale, Design and Behavioral Baseline Equivalence of the Community Youth Development Study

Recent advances in prevention science provide evidence that adolescent health and behavior problems can be prevented by high-quality prevention services. However, many communities continue to use prevention strategies that have not been shown to be effective. Studying processes for promoting the dissemination and high-quality implementation of prevention strategies found to be effective in controlled research trials has become an important focus for prevention science. The Communities That Care prevention operating system provides manuals, tools, training, and technical assistance to activate communities to use advances in prevention science to plan and implement community prevention services to reduce adolescent substance use, delinquency, and related health and behavior problems. This paper describes the rationale, aims, intervention, and design of the Community Youth Development Study, a randomized controlled community trial of the Communities That Care system, and investigates the baseline comparability of the 12 intervention and 12 control communities in the study. Results indicate baseline similarity of the intervention and control communities in levels of adolescent drug use and antisocial behavior prior to the Communities That Care intervention. Strengths and limitations of the study’s design are discussed.

Reduced blood levels of reelin as a vulnerability factor in pathophysiology of autistic disorder.

Abstract1. Autism is a severe neurodevelopmental disorder with potential genetic and environmental etiologies. Recent genetic linkage reports and biochemical analysis of postmortem autistic cerebellum point to Reelin, an important secretory extracellular protein, as being involved in the pathology of autism.2. We hypothesized that blood levels of Reelin and its isoforms would be altered in autistic twins, and their first degree relatives versus normal controls.3. We measured blood levels of unprocessed Reelin (410 kDa) and its proteolytic cleavage products (Reelins 330 and 180 kDa) as well as albumin and ceruloplasmin in 28 autistic individuals, their parents (13 fathers, 13 mothers), 6 normal siblings, and 8 normal controls using SDS-PAGE and western blotting.4. Results indicated significant reductions in 410 kDa Reelin species in autistic twins (−70%, p < 0.01), their fathers (−62%, p < 0.01), their mothers (−72%, p < 0.01), and their phenotypically normal siblings (−70%, p < 0.01) versus controls. Reelin 330 kDa values did not vary significantly from controls. Reelin 180 kDa values for parents (fathers −32% p < 0.05 vs. controls, mothers −34%) declined when compared to controls. In contrast autistic Reelin 180 kDa increased, albeit nonsignificantly versus controls. Albumin and ceruloplasmin values for autistics and their first degree relatives did not vary significantly from controls. There were no significant meaningful correlations between Reelin, albumin and ceruloplasmin levels, age, sex, ADI scores, or age of onset.5. These results suggest that Reelin 410 deficiency may be a vulnerability factor in the pathology of autism.

Predictors of Treatment Response in Anxious-Depressed Adolescents With School Refusal

OBJECTIVE To identify predictors of treatment response to 8 weeks of cognitive-behavioral therapy (CBT) among anxious-depressed adolescents with school refusal, half of whom received imipramine plus CBT and half of whom received placebo plus CBT. METHOD A hierarchical multiple regression analysis was used to evaluate the following variables as potential predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and presence of avoidant disorder (AD). RESULTS Baseline attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51% of the variance in outcome. Specifically, a higher rate of attendance at baseline and receiving imipramine predicted a better response to treatment whereas the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also evaluated. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than females. CONCLUSIONS Adolescents with school refusal are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity at the start of treatment should be taken into consideration when planning treatment.

Psychiatry, moral worry, and the moral emotions.

There has been increased philosophical, psychological, and, more recently, psychiatric interest in the moral emotions, most specifically the emotions of guilt, shame, regret, and remorse. Interest in these emotions has not been in their role as symptoms of a particular mental illness, but in their presence in everyday life and in their importance in defining our character and our very humanity. Moral emotions are those emotions that arise in the context of life experiences and daily choices that bear upon our perceptions of the rightness or wrongness of particular actions or inactions. Human beings have a moral scanner that constantly provides both a cognitive judgment and a feeling tone of ease or unease in the moral evaluation of life’s moment-to-moment activities. This paper discusses the intersection of psychiatry and the moral emotions, providing case examples and a review of empirical studies to illustrate the relevance of patients’ concerns about their moral choices to psychiatric evaluation and practice.

The early risers longitudinal prevention trial: examination of 3-year outcomes in aggressive children with intent-to-treat and as-intended analyses.

The effects of participation following a 3-year preventive intervention trial targeting elementary school children with early-onset aggressive behavior were evaluated. Intent-to-treat analyses revealed that program participants, compared with controls, showed greater gains in social skills, academic achievement, and parent discipline, with mean scores in the normative range on the latter two constructs. As-intended participation in the Family Program, which included separate parent and child education and skills-training groups, was associated with improved parent discipline practices and gains in childrens social skills, with level of child aggression moderating gains in academic achievement. Recommended level of FLEX family support contact time was associated with gains in academic achievement, concentration problems, and social skills, with parents of severely aggressive children showing greater reductions in parent distress.

Parceling Component Effects of a Multifaceted Prevention Program for Disruptive Elementary School Children

This study examined predictors and outcomes of attendance in two standard components of a multifaceted preventive intervention aimed at children with early-onset disruptive behavior after 3 years of intervention. Mean rate of attendance in the Family Program, but not the Summer School Program, differed by level of child disruptiveness (grouping variable). Although predictors of attendance (SES, single-parent status, child IQ) did not differ across high- and low-disruptive groups, predictors of outcome were moderated by level of child disruptiveness for academic achievement and aggression outcomes, but not for social competence. Higher attendance in the Summer Program was associated with higher child social competence at Year 3 for all children. For academic achievement, higher attendance in the Summer Program was associated with higher scores for mild/moderately disruptive children and lower scores for highly disruptive children in Year 3. Higher attendance in the Family Program was associated with lower aggression scores for mild/moderately disruptive children. Findings highlight the importance of matching intervention components to the assessed or expressed needs of client subgroups.

Four years of the early risers early-age-targeted preventive intervention: Effects on aggressive children's peer relations

Peer nominations for behavioral reputation, likability, and friendship were examined after 4 years of an ongoing randomized, controlled prevention trial designed to interrupt the developmental trajectory of young aggressive children by improving peer relations. Participants included 125 moderately to highly aggressive children (program and control) and their 4th-grade classmates (N = 1,489). Results indicated that program children, as compared to controls, obtained higher reputation scores on leadership and social etiquette and chose friends with lower aggression. Self-reported quality of friendship also differed between groups, with program children reporting more companionship and recreation, program girls reporting more validation and caring, and severely aggressive program children reporting less aggression toward others than their control counterparts. These findings provide evidence for the generalization of program effects to a natural peer setting.

Measuring adolescent drug abuse and psychosocial factors in four ethnic groups of drug-abusing boys.

There is an absence of empirical work on the measurement of adolescent drug abuse among non-White ethnic youths. The field would benefit from psychometrically sound measures for ethnic groups. The psychometric properties of a multi-scale assessment tool for adolescent drug abuse, the Personal Experience Inventory (PEI), have been examined largely in White samples. The current study reports reliability and validity data for the PEI across four samples of boys (White, African American, Native American, and Hispanic). The results provide general psychometric support for the non-White groups. The use and limitations of the PEI in different ethnic/racial groups are discussed.

Moral conflict, religiosity, and neuroticism in an outpatient sample.

Our sense of identity is inextricably connected to our sense of ourselves as moral beings. However, concerns about the rightness and wrongfulness of our own actions, and a range of emotions connected to moral worry, such as regret and remorse, rarely receive clinical attention. The present study sought to develop and operationalize the construct of moral concern or worry in a psychiatric outpatient sample and to investigate relationships between moral worry and age, gender, religiosity, and the tendency to worry in general. The Eysenck Personality Inventory, Duke Religiosity Scale, and a 20-item Worry Scale (containing eight moral worry items) were administered to 225 psychiatric outpatients. Data analysis included principal components analysis, repeated measures MANOVA to examine extent of worry among factor scales and interactions between age and sex, and multiple regression to identify significant correlates of each factor scale. Worry about moral issues emerged as a domain distinct from worry about practical matters. Although respondents reported more worry about practical matters than about moral concerns, worry about the former declined with age, whereas worry about the latter did not. Intrinsic religiosity was negatively correlated and neuroticism positively correlated with both scales. Because patients are concerned about the moral aspects of their character and behavior, this area deserves further research and consideration.

Moral conflict as a component of ordinary worry.

This article contributes to the psychology of moral behavior by inquiring into the presence and extent of worrying about moral concerns in ones life relative to worrying about practical concerns. A 20-item questionnaire was developed, mixing eight moral worry questions with twelve ordinary worry items (finances, health) identified in previous research on worry. Factor analysis produced three domains of worrisome thinking: moral concerns, social desirability, and personal and family health. A single item inquiting into worry about not living up to Gods expectations did not load onto any other factor and was dropped from further analysis. Internal consistency for the moral worry factor scale was .85. Mean scores for this scale (moral domain) were significantly lower than mean scores for the two practical worry domain factors. Limitations of the study and directions for further research are outlined.