Martha U. Barnard

Treating Childhood Depression over Videoconferencing

Effective cognitive-behavioral treatments for childhood depression have developed over the last decade, but many families face barriers to such care. Telemedicine increases access to psychological interventions by linking the child and the clinician using videoconferencing (VC). The current study evaluated an 8-week, cognitive-behavioral therapy (CBT) intervention for childhood depression either face-to-face (F2F) or over VC. The telemedicine setup included two PC-based PictureTel systems at 128 kilibits per second (kbps). Success was defined by (1) decreasing depressive symptoms at similar rates in both the VC group and the F2F group and (2) demonstrating the feasibility of a randomized controlled trial in telemental health. Children were assessed for childhood depression using the mood section of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present Episode (K-SADS-P). Twenty-eight children were randomized to either F2F or VC treatment. The participants completed the K-SADS-P and the Childrens Depression Inventory (CDI) at pre- and post-treatment. The CBT treatment across the two conditions was effective. The overall response rate based on post-evaluation with the K-SADS-P was 82%. For the CDI total score, both the Time and the Group by Time effects were significant (p < 0.05). The interaction effect reflected a faster rate of decline in the CDI total score for the VC group. The study serves as a model for building on past research to implement a randomized controlled trial. This information provides persuasive research data concerning treatment effectiveness for clinicians, families, and funders.

Interrelationships among Variables Affecting Well Siblings and Mothers in Families of Children with a Chronic Illness or Disability

A structural equation model (SEM) examined interrelationships among psychosocial variables known to affect the health and development of well siblings and parents when a child with a chronic illness or disability is a member of the family. Using dyads of 252 well children and parents, socioeconomic status (SES) and family cohesion were associated with the parent-reported behavior of the well sibling. SES also influenced the mood of the mother that in turn influenced family cohesion. The well siblings knowledge about the illness of the brother or sister, attitude toward the illness, mood, self-esteem, and feelings of social support were interrelated and related to the behavior of the well sibling. The SEM suggests that interventions may be directed at several points in these interactions including boosting knowledge levels of the well sibling, improving family cohesion, and assuring adequate “income” support to the family through income transfers or in-kind services.

A community-based intervention for siblings and parents of children with chronic illness or disability: the ISEE study.

OBJECTIVE Siblings of children with chronic illness or disability have been reported to have a 1.6 to 2.0 risk for behavioral and mental health problems. Our objective was to examine the effects of an intervention for siblings (age 7-15 years) of children with chronic illness or disability. METHOD A randomized, three-group repeated-measures design was used: full intervention (n=79), partial intervention (n=71), and a waiting list control group (n=102). Outcomes were sibling knowledge about illness, behavior problems, social support, self-esteem, attitude, and mood measured over four postintervention periods. Covariates were family cohesion, maternal mood, socioeconomic status, and well sibling age. The full intervention included structured teaching and psychosocial sessions at a 5-day residential summer camp. The partial intervention included camp only. Treatment effects were estimated by using generalized estimating equation panel analyses. RESULTS The full treatment group showed significant improvements on all six outcomes over most periods, the partial treatment group on three outcomes, and the control group on two outcomes. Improvements in outcomes ranged from 5% to 25% increases over baseline measures. CONCLUSIONS A dose-response relationship to intervention was found. Treatment gains were sustained over a period of 12 months.

Psychosocial Adjustment and the Role of Functional Status for Children with Asthma

This study examined the psychosocial adjustment of children with asthma compared to children with diabetes, with cancer, and healthy children and the role of functional status in psychosocial adjustment. The total sample included 100 children, aged 8-16 years, (mean = 11.5 years), consisting of 48 boys and 52 girls. Children with asthma scored significantly higher on measures of affective adjustment (depression and internalizing behavior), significantly lower on self-esteem, and evidenced significantly greater functional impairment. Children with cancer missed significantly more school days. After controlling for functional status, no significant differences remained in affective adjustment but absences remained significantly higher for the children with cancer.

Feasibility of telemedicine intervention for childhood depression

Abstract Context: Childhood depression is associated with high short-term and long-term morbidity. Cognitive-behavioural therapy (CBT) for depression has been supported as an effective treatment in the traditional clinic setting. But many families face barriers to depression treatment, including distance to providers, provider shortages, stigma, and other challenges. Telemedicine or interactive televideo offers an innovative way to provide therapy at a distance. The family and therapist see and hear each other in real-time using videoconference. Objective: This pilot project evaluated the same cognitive-behavioural therapy treatment for childhood depression in two different settings — face-to-face (F2F) or over interactive televideo (ITV). Participants: Twenty-eight children with depression and their caregivers completed an eight-session, empirically supported CBT course for parent and child. Results: All parent and child CBT skills were implemented successfully over telemedicine. An 82% remission from de...

Improving Adherence to Inhaled Corticosteroids in Children With Asthma: A Pilot of a Randomized Clinical Trial

This study examined the efficacy of an educational and behavioral intervention designed to improve adherence to inhaled corticosteroids in children with asthma. Fifteen children and their caregivers were randomly assigned to either a targeted educational and behavioral intervention (treatment group) or a broader psychoeducational condition (comparison group). Given the small sample size, data were analyzed using pooled time series analysis (PTSA), a unique statistical methodology that treats observations for each participant as a separate case and provides statistical power in small samples. Participants in the treatment group showed significant improvements in adherence (16.38%) during the intervention. Participants in both groups also made clinically meaningful improvements in pulmonary function. This study addressed various limitations of previous intervention research and demonstrated that a targeted intervention including educational and behavioral components was effective in improving adherence to inhaled corticosteroids in children with asthma. Implications for adherence interventions are discussed.

Problems and interventions of a pediatric psychology clinic in a medical setting: A retrospective analysis

This article provides descriptive information of an outpatient pediatric psychology clinic in a major medical center in a metropolitan area. The characteristics of 250 patients were coded from archived files, representing a random sample of 10% of all cases referred. The majority of patients were boys between 2 and 12 years of age and the most frequent presenting problems were externalizing problems, such as noncompliance, attention problems, hyperactivity, and aggression. Behavioral treatments were administered for the majority of the patients. This study demonstrates the practice patterns of a psychology unit in a pediatric setting. The findings belie a characterization of the field of pediatric psychology as only medically related applications, but point to issues of successfully fulfilling the needs of referral sources and expanding marketing niches.

Mediators of Psychological Adjustment in Children and Adolescents with Short Stature

Short stature is defined as growth below the fifth percentile for chronological age, or as height greater than 2 standard deviations (SDS) below the mean height for chronological age (1,2). Approximately 5 percent of all children (1.27 million) have significant short stature (SS) in the United States (2,3). Many posttreatment studies of children and adults treated for growth hormone deficiency (GHD) as children have shown these individuals to have poorer psychological and social adjustment than their normally developing peers (4-7). Higher unemployment rates (5), lower marriage rates (5), and increased incidents of psychiatric disorders and social phobia are reliably reported (7,8).