Kurt A. Freeman

Family Therapy for Adolescents with Poorly Controlled Diabetes: Initial Test of Clinical Significance

OBJECTIVE We examined a structured family therapy approach in promoting clinically meaningful improvements in parent-adolescent conflict in adolescents with poorly controlled diabetes. METHOD Eighteen adolescents with poorly controlled diabetes and their parent(s) participated in 10 sessions of home-based Behavioral Family Systems Therapy (BFST). Outcome comparisons were made using a sample of adolescents with poorly controlled diabetes (n = 40) from a previous study. Clinically significant improvements were determined by calculating SD differences between treatment and comparison groups on measures of diabetes-related and general parent-adolescent conflict. RESULTS Home-based BFST produced change in diabetes-related family conflict ranging from 1/3 to 1/2 SD and general family conflict ranging from 1/3 to 3/4 SD. CONCLUSIONS BFST produced change in family conflict, a variable shown through previous research to relate to treatment adherence in adolescents with diabetes. The test of clinical significance represents an example of a method useful for pediatric research.

Seeing Is Believing: Using Skype to Improve Diabetes Outcomes in Youth

OBJECTIVE The objective of this study was to compare the relative effectiveness of two modes of delivering Behavioral Family Systems Therapy for Diabetes (BFST-D) to improve adherence and glycemic control among adolescents with type 1 diabetes with suboptimal glycemic control (HbA1c ≥9.0% [≥74.9 mmol/mol]): face to face in clinic (Clinic) and Internet videoconferencing (Skype) conditions. RESEARCH DESIGN AND METHODS Adolescents aged 12 to 18 years and at least one adult caregiver were randomized to receive BFST-D via the Clinic or Skype condition. Participants completed up to 10 therapy sessions within a 12-week period. Changes in youth- and parent-reported adherence and glycemic control were compared before and after the intervention and at follow-up assessment. RESULTS Using an intent-to-treat analytic approach, no significant between-group differences were identified between the before, after, and follow-up assessments. Groups were collapsed to examine the overall effects of BFST-D on adherence and glycemic control. Results identified that statistically significant improvements in adherence and glycemic control occurred from before to after the intervention; improvements were maintained at 3-month follow-up. CONCLUSIONS Delivery of BFST-D via Internet-based videoconferencing is viable for addressing nonadherence and suboptimal glycemic control in adolescents with type 1 diabetes, potentially reducing important barriers to care for youth and families.

Treatment of Smith-Lemli-Opitz Syndrome and Other Sterol Disorders

Smith–Lemli–Opitz syndrome (SLOS) is an autosomal recessive genetic condition with a broad phenotype that results from deficiency of the final enzyme of the cholesterol synthesis pathway. This defect causes low or low‐normal plasma cholesterol levels and increased 7‐ and 8‐dehydrocholesterol (DHC) levels. Many therapies for SLOS and other disorders of sterol metabolism have been proposed, and a few of them have been undertaken in selected patients, but robust prospective clinical trials with validated outcome measures are lacking. We review the current literature and expert opinion on treatments for SLOS and other selected sterol disorders, including dietary cholesterol therapy, statin treatment, bile acid supplementation, medical therapies, and surgical interventions, as well as directions for future therapies and treatment research.

Behavioral Health Care for Adolescents with Poorly Controlled Diabetes via Skype: Does Working Alliance Remain Intact?

Background: Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Methods: Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≤9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. Results: No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Conclusion: Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care.

Treatment of juveniles who sexually offend: An overview

SUMMARY Juvenile sexual offending is increasingly being recognized as a serious crime among youth. The prevalence of sexual offending and sexual reoffending suggests that many juvenile sex offenders (JSOs) may repeat their offending behaviors if not treated. However, clinical trials evaluating specific interventions are virtually nonexistent. Instead, the literature on the treatment of JSOs is marked by discussions of strategies that are hypothesized to be beneficial, as well as descriptions of treatment programs that exist across the country. Further, while existing literature suggests that treatment for JSOs may deter future sexual offending behaviors, it is unclear which, if any, aspects of these treatments promote the development of positive behaviors. A discussion of existing treatment approaches, effectiveness, and treatment considerations follows.

Using Self-Monitoring With an Adolescent with Disruptive Classroom Behavior: Preliminary Analysis of the Role of Adult Feedback.

Current research supports the effectiveness of self-monitoring strategies for addressing academic and behavioral challenges within educational settings. Although variations in procedures exist, frequently implementation of self-monitoring involves some form of adult feedback as a method of establishing accurate self-monitoring. To date, however, researchers have not systematically evaluated whether adult feedback is a necessary component for self-monitoring to be effective. In the current investigation, the influence of adult feedback on the effectiveness of selfmonitoring was analyzed. The participant was a 13-year-old student receiving educational services in a special education school at a residential facility for youth with conduct problems. The effectiveness of self-monitoring with and without adult feedback was compared. Results suggest that adult feedback may be an important component for establishing self-monitoring as an effective intervention for behavior problems exhibited in academic settings.

Private events: Do they belong in a science of human behavior?

The role of thinking, feeling, and other private events has received a great deal of attention in mainstream psychology but has been virtually ignored in behavior analysis until recently. This paper introduces a series of papers from a symposium that explored the roles of private events in a science of human behavior. We briefly explore the role private events are assigned in several behavioral orientations. Next, we discuss several positions on how private events might be conceptualized within a behavior-analytic framework. We conclude by noting that the dearth of research and conceptualizations about private events unnecessarily limits the theoretical or conceptual understanding on which applied behavior analysts base their work. With this paper and the papers that follow, we hope to spark research, discussion, and yes, thinking, about the roles of thinking and feeling.

Testing the feasibility of a National Spina Bifida Patient Registry

BACKGROUND The purpose of this study was to describe the development and early implementation of a national spina bifida (SB) patient registry, the goal of which is to monitor the health status, clinical care, and outcomes of people with SB by collecting and analyzing patient data from comprehensive SB clinics. METHODS Using a web-based, SB-specific electronic medical record, 10 SB clinics collected health-related information for patients diagnosed with myelomeningocele, lipomyelomeningocele, fatty filum, or meningocele. This information was compiled and de-identified for transmission to the Centers for Disease Control and Prevention (CDC) for quality control and analysis. RESULTS A total of 2070 patients were enrolled from 2009 through 2011: 84.9% were younger than 18 years of age; 1095 were women; 64.2% were non-Hispanic white; 6.5% were non-Hispanic black or African American; and 24.2% were Hispanic or Latino. Myelomeningocele was the most common diagnosis (81.5%). CONCLUSIONS The creation of a National Spina Bifida Patient Registry partnership between the CDC and SB clinics has been feasible. Through planned longitudinal data collection and the inclusion of additional clinics, the data generated by the registry will become more robust and representative of the population of patients attending SB clinics in the United States and will allow for the investigation of patient outcomes.

Psychometric properties of the Questions About Behavioral Function scale in a child sample

The Questions About Behavioral Function (QABF) scale is a caregiver report form designed to identify behavioral functions important in maintaining aberrant behavior. In the present investigation, we evaluated the psychometric properties of the QABF with an outpatient sample of 91 children with developmental delays and significant aberrant behavior (e.g., physical aggression, self-injury, and property destruction). One caregiver completed the QABF and Motivation Assessment Scale on aberrant behavior identified in a preappointment interview for each child. Results indicate that the QABF exhibited fair to good internal consistency, strong corrected item-total correlations, acceptable intersubscale correlations, and convergent validity with the Motivation Assessment Scale. Implications of the results, potential utility of caregiver report instruments, study limitations, and future directions are discussed.

Recidivism and resilience in juvenile sexual offenders: an analysis of the literature.

SUMMARY The majority of research that exists studying juvenile sex offenders (JSOs) is dominated by the predilection that identifying risk factors associated with recidivism will benefit both the JSOs and treatment providers. Further, the majority of existing treatments are guided by research that has identified what makes JSOs more likely to reoffend. Absent from the majority of the literature is an examination of the strengths and positive characteristics demonstrated by JSOs that may prove useful in both reducing recidivism and increasing the likelihood of achieving positive outcomes (i.e., demonstrating resilience). Research examining known risk factors for sexual and nonsexual recidivism is described. Next, literature on resilience is reviewed, followed by a discussion of this literature in the context of treatment for JSOs. Finally, future directions of research are presented.