Marietta H. Collins

Family‐based interventions for child and adolescent disorders.

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.

A Developmental Psychopathology Perspective on the Cognitive Components of Child and Adolescent Depression

Multiple pathways lead to the development of depression, and myriad factors account for its maintenance and recurrence. For some youth, cognitive factors are central to the development, maintenance, and/or recurrence of their depression (e.g., Asarnow & Bates, 1988); these youth are the primary focus of this chapter. Depressed youth, even those for whom cognitive factors are not the most salient component of their presentation, typically evidence cognitive correlates of their depression; therefore, this discussion is relevant to them as well. As Garber (1992) aptly points out, it is essential that attention be paid to examining the cognitivediathesis-stress models in children, rather than just focusing on the link between a specific cognitive process and depression. According to these models, individuals with a cognitive vulnerability to depression are most likely to evidence depression in the face of stress. This emphasis on cognitive-diathesis-stress models needs to incorporate a developmental perspective in order to ascertain the extent and nature to which there is a cognitive-diathesis x stress interaction in predicting depression for youth at different developmental stages.

Psychosocial Considerations in Sickle Cell Disease (SCD): The Transition from Adolescence to Young Adulthood

Sickle cell disease (SCD) occurs in 1 of every 400 to 500 African American births. Despite its prevalence, there has been a relative dearth of attention paid to SCD in the psychological literature. African American SCD adolescents and young adults, individuals at an already vulnerable developmental stage, are at increased risk for psychological distress and psychosocial impairments (e.g., depression and low self-esteem, poor social and academic/vocational functioning). Such difficulties often result in problematic adherence to medical regimens, and thus represent a potentially serious clinical and public health problem that merits the attention of psychologists working in medical settings. This article (1) reviews the psychosocial needs peculiar to SCD patients transitioning from adolescence to young adulthood; (2) applies a culturally informed stress-coping-adjustment framework to assess and address the psychological status, psychosocial functioning, and disease outcomes of these individuals; and (3) describes a culturally and developmentally sensitive, psychoeducational group intervention.

Psychosocial Interventions for Children and Adolescents with Sickle Cell Disease (SCD)

Sickle cell disease (SCD), a chronic, hereditary, and congenital blood disorder, affects I in every 400 to 500 African American babies. In addition to experiencing myriad medical problems, children and adolescents in whom SCD has been diagnosed often manifest neurocognitive impairments and learning problems, internalizing and externalizing of behavior problems, problematic interpersonal relationships, low self-esteem, and maladaptive coping patterns. Despite the proliferation of research on medical interventions for SCD, there is a paucity of data on effective psychosocial interventions. This article reviews both the existing psychosocial interventions and related empirical literature for SCD youth. As many psychosocial treatment options were initially designed for SCD adults, developmentally appropriate modifications for children and adolescents will be offered. Particular attention is paid to nonpharmocologic pain management strategies (i.e., biofeedback and relaxation training, self-hypnosis, behavioral contracting, coping skills training, patient-controlled analgesic medications); educational programs, self-help and support groups; andfamily counseling and therapy.

Individual and Family Contributions to Depressive Symptoms in African American Children with Sickle Cell Disease

Depressive disorders in children with chronic illnesses have received little attention despite some evidence suggesting that these children experience increased psychological difficulties as a result of their medical condition. Most of the research on depressive disorders among children has been conducted primarily with Caucasian youth, limiting generalizability to ethnically diverse populations. Further, even less research exists on depressive disorders among African American children with Sickle Cell Disease (SCD) and for African American youth from lower socioeconomic status who are at greater risk for depressive disorders. This paper is an extensive review of the major studies conducted on depression and psychosocial aspects of SCD in African American children. The Transactional Stress and Coping model is provided as a conceptual framework. Following the review, clinical and research implications are provided, as well as an illustration of a psychoeducational family intervention with an African American child who has SCD and internalizing behaviors.

Clinically Significant Depressive Symptoms in African American Adolescent Females in an Urban Reproductive Health Clinic

Adolescent depression is a major public health concern. Depression and depressive symptoms are more prevalent in adolescent females and are associated with high-risk sexual behavior. Only one third of adolescents receive professional help for their depression, although about 90% visit their primary care providers on average 2–3 times per year. It is imperative that health professionals seek additional methods in the identification and treatment of depressive symptoms. This paper presents findings of the presence of clinically significant depressive symptoms in African American female adolescents receiving routine health care services within an adolescent primary care reproductive health clinic. Results revealed higher rates of depressive symptoms in this subsample of African American adolescent females when compared to the national sample, suggesting that primary care reproductive health clinics are a viable setting for the identification of depressive symptoms among low income, African American female adolescents. Psychosocial interventions and recommendations for the integration of primary care reproductive health, and behavioral health consultation services are presented.

Applicability of Criteria for Empirically Validated Treatments to Family Interventions for Pediatric Sickle Cell Disease

One in every 400–500 African American babies carries a diagnosis of sickle cell disease (SCD). SCD, a congenital, hereditary hematologic disorder places youth at risk for developing potentially serious and life threatening disease related medical problems. Many SCD youth manifest neurocognitive impairments and learning problems, externalizing and internalizing behavior problems, difficulties in interpersonal relationships, low self-esteem, and problematic disease coping. Compared to control families, families with an SCD child have more conflict and lower levels of family organization. In contrast to the burgeoning research on medical advances, few researchers have examined the psychological sequelae of SCD or effective psychosocial interventions. With Americas changing health care climate, the need for psychologists to work with medically ill individuals in primary care settings is increasing. In response to this need and to the 1995 American Psychological Associations guidelines for treatment efficacy studies, a manualized family-oriented treatment program for pediatric SCD patients was developed. This paper discusses the strengths and challenges associated with implementing a culturally and developmentally sensitive manual-based family intervention for a low SES African American chronically ill population. Possible solutions to the challenges of conducting family-oriented intervention efficacy studies with pediatric populations are presented.

The Challenge of Transporting Family-Based Interventions for Adolescent Substance Abuse from Research to Urban Community Settings

Motivated by concerns about the extent to which urban African American youth under-report substance abuse, the extent to which they are over-represented in drug-related criminal justice settings, and the extent to which research on adolescent substance abuse treatment has lagged in settings serving urban minority populations, the authors comment on some factors to consider when conducting family-based interventions and research with such populations. They offer recommendations based on experience implementing a community-based treatment program for urban substance-abusing adolescents, patient demographic data gathered from the program, and their attempt at adding a family-based treatment component to the program.