Jeffrey N. Wherry

School age children's coping with sexual abuse: abuse stresses and symptoms associated with four coping strategies

Strategies used by 84 sexually abused children, ages 7 to 12, to cope with their abuse were evaluated, along with child abuse-related symptoms, parent-reported behavioral symptoms, and teacher-reported behavioral symptoms. Principal components analysis of coping yielded four strategies that were labeled avoidant coping, internalized coping, angry coping, and active/social coping. Each coping strategy was found to be associated with a unique set of abuse characteristics, abuse-related social environment, and symptoms. In contrast to findings with adult survivors and adolescents, use of avoidant coping strategies among school-age children was found to be related to fewer behavioral problems, although it was also associated with greater sexual anxieties. Internalized coping was found to be associated with increased guilt and PTSD hyperarousal symptoms. Active/social coping was the only strategy found to be unrelated to symptoms, but neither was it associated with measured benefits. In contrast to some clinical opinion that externalizing blame and venting anger is a helpful strategy, angry coping was found to be associated with a wide range of behavioral and emotional problems as rated by the childs home-room school teacher. Results are discussed in terms of a proposed mediational model.

The utility of the Beck anxiety inventory with inpatient adolescents

Abstract This study is the first to examine the reliability, convergent validity, and discriminant validity of a new adult self-report measure of “pure” anxiety, the Beck Anxiety Inventory (Beck et al., 1988; Beck & Steer, 1991), with adolescents (N = 80). The BAI appears readable for 14-year-old patients with average reading skills. It has high internal consistency (alpha = .94), acceptable item-total score correlations (M = .66), and moderate to high concurrent validity; that is, the BAI correlated significantly with clinician ratings (r = .40) and self-report (r = .58) measures of anxiety. The results of the BAIs ability to discriminate anxiety from depression were mixed, based on the method utilized to assess this relationship. Whereas the BAI demonstrated moderate discriminant validity with the clinician ratings, the BAI converged significantly with the self-report depression measure. Anxiety-disordered adolescents scored significantly higher (31.5) than adolescents with depressive disorders (13.1) on the BAI. Results demonstrate that the BAI can be used validly and reliably in clinical practice, as well as in research with severely disturbed adolescents.

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.

Concurrent and Discriminant Validity of the Gordon Diagnostic System: A Preliminary Study.

The discriminant and concurrent validity of the Gordon Diagnostic System (GDS) was investigated in 29 youngsters categorized into “normals” or “ADHDs” based on teacher ratings. The results failed to demonstrate the discriminant validity of any GDS score regardless of the behavior rating used. The Vigilance Correct and Vigilance Omission scores were significantly correlated with ADHD Rating Scale scores completed by teachers. The sample size in the study demands cautious interpretation of these results; however, the authors suggest the continued use of multiple behavior ratings by teachers as the “gold standard” for the classification of youngsters with a suspected Attention-deficit Hyperactivity Disorder.

A national survey of child advocacy center directors regarding knowledge of assessment, treatment referral, and training needs in physical and sexual abuse.

Mental health services are a core component of child advocacy centers in the United States. Child advocacy center directors were surveyed about (a) trauma and posttraumatic stress disorder; (b) referral criteria for treatment of abuse victims; (c) evidence-based treatments for abused children; (d) reliable, valid, and normed measures helpful in assessment; and (e) training needs. Directors accurately identified posttraumatic stress disorder symptoms, but additional symptoms were misidentified. Directors identified best practices for assessment and treatment, but they misidentified non-evidence-based practices. Primary reasons for referral for services included severity of abuse and emotional response of the child. However, referrals based on assessment findings were not a high priority. Directors expressed some training needs for staff consistent with issues identified in the study.

Factors associated with respite care use by families with a child with disabilities

This paper reviews the literature on respite care utilization, describes a respite care program in Arkansas, and reports on a study of utilization initiated by the Arkansas Division of Mental Health Services (DMHS). Among the 89 families qualifying for respite services, 70 consented to participate, and 66 were surveyed in a phone interview. Users (n=54) and non-users (n=12) were compared relative to a variety of staff, child, geographic, and budget differences. Also, respite use was examined relative, to the aforementioned variables based on level of use, (i.e., none, low, moderate, high). There were no differences in use according to age, the number of family members, family income, or needs of the child. A larger percentage of non-use and low use of respite care was evident among those families receiving Tax Equity Fiscal Responsibility Act (TEFRA) benefits. There were no significant differences between races related to perceived barriers to care. Differences in expectations/experiences with respite care among rural and urban groups were limited with rural respondents expressing, concern about travel/distance issues. Overall, the program as a whole received positive ratings by parents, and no clear factors were found to be related to non-use in the small sample (n=12) who did not take advantage of respite services.

Differential Diagnosis and Treatment of Conversion Disorder and Guillain-Barre Syndrome

Three cases are presented which illustrate the possible difficulties in differentiating between the diagnoses of Guillain-Barre Syndrome and conversion disorder. Accepted criteria are specified for each condition, as well as some associated features often characteristic of similar cases. Supportive interdisciplinary treatment for Guillain-Barre Syndrome is reviewed, and an interdisciplinary multi-modal approach to treatment of conversion disorder is described.