Mark E. Prange

Substance Abuse Prevalence and Comorbidity with Other Psychiatric Disorders among Adolescents with Severe Emotional Disturbances

Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.

A comparison of children with serious emotional disturbance served in residential and school settings

The National Adolescent and Child Treatment Study (NACTS) was designed to study children identified and served by the public mental health and special education systems as seriously emotionally disturbed. Children (N=812) and their parents (N=740) participated in the first wave of data collection in this longitudinal study. Subjects lived in six states, with approximately half in psychiatric residential treatment centers and the other half in public school special education programs. A multi-method, multi-source methodology was employed. The sample is characterized by externalizing problems, poor adaptive functioning, and substantial academic deficits. Residential children were more likely to have blended families, were more likely to have previously received residential treatment, and had higher rates of conduct disorder, anxiety, and attention deficit disorder, as measured by the Diagnostic Interview Schedule for Children. The two groups did not differ on intelligence, age of onset, or rates of schizophrenia or depression. The data suggest the presence of greater at-risk factors in the residential group and different paths of entry into special education and residential treatment programs.

Children lost within the foster care system: Can wraparound service strategies improve placement outcomes?

The proportion of children with emotional and behavioral disturbances within the foster care system in the United States is continuing to increase. Many of these children experience numerous placement changes each year, often into extremely restrictive settings. The Fostering Individualized Assistance Program (FIAP) study examined the feasibility of applying a wraparound strategy to these children and their foster, biological and/or adoptive families. This FIAP wraparound strategy paralleled the foster care system and involved the clinical case management of a broad range of individually tailored services, driven by a wraparound team of adult key players in each childs life. This was a controlled study which involved the random assignment of 132 children (ages 7–15 years) to the FIAP wraparound group or to a group that received usual foster care services. We provide a description of the FIAP wraparound intervention and findings that support the efficacy of this strategy in improving the placement outcomes for children lost in the foster care system. Discussion focuses on systemic and intervention factors that may be improved upon to strengthen future individualized wraparound processes and evaluation/research efforts.

Family functioning and psychopathology among adolescents with severe emotional disturbances

Family psychosocial functioning and its relation to psychopathology among adolescents with severe emotional disturbances (SED) was assessed. Subjects were 353 adolescents with SED, ages 12–18, and their parents. During a semistructured interview, adolescents were administered Family Adaptability and Cohesion Evaluation Scale (FACES-III), Diagnostic Interview Schedule for Children-Child Version (DISC-C), and the Self-Derogation Scale. Parents were administered FACES-IIII and the Child Behavior Checklist (CBCL) in a phone interview. Results indicated that on the FACES-IIII cohesion dimension, both parents and adolescents perceived their family relations as more disengaged and less connected than did normative families (p < .001). In contrast, only parent FACES-IIII adaptability scores were significantly more extreme than a normative sample (p < .01). Additionally, both parent and adolescent cohesion scores were significantly correlated with adolescent psyehopathology measures: DISC-C conduct disorder (p < .01), depression (p < .05), alcohol/marijuana (p < .01), and CBCL externalizing symptoms (p < .01). These relationships did not deviate from linearity.

Improving Adjustment Outcomes For Foster Children With Emotional And Behavioral Disorders Early Findings From A Controlled Study On Individualized Services

This study was a community-based, controlled experiment to evaluate the efficacy of the Fostering Individualized Assistance Program (FIAP), which was driven by permanency (i.e., a stable placement in a supportive family) and family-focused values and involved the wrapping of services around children, based on their individual needs and those of their families. The services and supports were intensely case managed to ensure that these could be adjusted as childrens situations and needs changed. The study involved a comparison of 132 children in foster care with, or at risk for, emotional and behavioral disorders, who were randomly assigned to the FIAP program or to a group that received standard-practice foster care. A description of the FIAP intervention and a report of preliminary results that support the efficacy of the FIAP strategy in improving the emotional and behavioral adjustment of children in foster care are presented.

Self-reported and self-monitored smoking patterns

Individual differences in smoking patterns are usually assessed with self-report measures such as Horns Reasons for Smoking Test, which have not been systematically validated. This paper compares results from several self-report scales with self-monitoring data obtained from 164 smoking clinic subjects who monitored their smoking for at least two days. Self-monitoring data were factor-analyzed and correlated with self-report measures. Most of the hypothesized relationships failed to appear. The Sedative Smoking (tension-reduction) factor of the Reasons for Smoking Test received the strongest support. In general, however, the results did not support the validity of commonly-used self-report scales of smoking motives and situations.

Patterns of Alcohol Abuse Among Black and White Alcoholics

The drinking practices of a matched sample of 78 Black and 78 White, male, hospitalized alcoholics were compared. The groups were matched on age and educational level; and they were equivalent in terms of marital and employment status, number of times hospitalized for treatment of alcoholism and other neuropsychiatric disorders, and number of arrests. The Alcohol Use Inventory was used to assess drinking practices. Significant multivariate and univariate analysis of variance indicated that (a) Whites reported greater daily consumption of alcohol, a tendency to perceive alcohol as a means of relieving psychological distress, and a greater level of psychological distress as a consequence of alcohol abuse than Blacks; and (b) Blacks reported a tendency to perceive alcohol as a means to improve mental functioning and to experience more serious psychoperceptual withdrawal symptoms than Whites.