Patricia A. Graczyk

Maternal depression and parenting behavior: A meta-analytic review

The results of 46 observational studies were analyzed to assess the strength of the association between depression and parenting behavior and to identify variables that moderated the effects. The association between depression and parenting was manifest most strongly for negative maternal behavior and was evident to a somewhat lesser degree in disengagement from the child. The association between depression and positive maternal behavior was relatively weak, albeit significant. Effects for negative maternal behavior were moderated by timing of the depression: Current depression was associated with the largest effects. However, residual effects of prior depression were apparent for all behaviors. Socioeconomic status, child age, and methodological variables moderated the effects for positive behavior: Effects were strongest for studies of disadvantaged women and mothers of infants. Studies using diagnostic interviews and self-report measures yielded similar effects, suggesting that deficits are not specific to depressive disorder. Research is needed to identify factors that affect the magnitude of parenting deficits among women who are experiencing depression and other psychological difficulties.

Child- and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorder: Development and Preliminary Results

OBJECTIVE To describe child- and family-focused cognitive-behavioral therapy (CFF-CBT), a new developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) that is intended for use along with medication. CFF-CBT integrates principles of family-focused therapy with those of CBT. The theoretical framework is based on (1). the specific problems of children and families coping with bipolar disorder, (2). a biological theory of excessive reactivity, and (3). the role of environmental stressors in outcome. CFF-CBT actively engages parents and children over 12 hour-long sessions. METHOD An exploratory investigation was conducted to determine the feasibility of CFF-CBT. Participants included 34 patients with PBD (mean age 11.33 years, SD = 3.06) who were treated with CFF-CBT plus medication in a specialty clinic. Treatment integrity, adherence, and parent satisfaction were assessed. Symptom severity and functioning were evaluated before and after treatment using the severity scales of the Clinical Global Impression Scales for Bipolar Disorder (CGI-BP) and the Childrens Global Assessment Scale (CGAS) respectively. RESULTS On completion of therapy, patients with PBD showed significant reductions in severity scores on all CGI-BP scales and significantly higher CGAS scores compared to pretreatment results. High levels of treatment integrity, adherence, and satisfaction were achieved. CONCLUSIONS CFF-CBT has a strong theoretical and conceptual foundation and represents a promising approach to the treatment of PBD. Preliminary results support the potential feasibility of the intervention.

Urban Educators’ Perceptions of Interventions for Students with Attention Deficit Hyperactivity Disorder: A Preliminary Investigation:

This study examined urban educators’ attitudes toward commonly recommended interventions for students with Attention Deficit Hyperactivity Disorder (ADHD). Participants included 358 pupil personnel services (PPS) professionals—school psychologists, social workers, and counselors—and 70 classroom teachers from urban elementary schools. On average, PPS professionals and classroom teachers expressed little confidence in the effectiveness of commonly used classroom, mental health, and pharmacological treatments for ADHD. For PPS professionals, a moderately positive correlation was found between self-confidence and effectiveness ratings for classroom interventions and mental health interventions, and a small positive association was found between knowledge of ADHD and effectiveness ratings for medication. Teacher self-confidence was positively associated with effectiveness ratings for classroom interventions. Knowledge of ADHD was negatively correlated with teacher perceptions of the effectiveness of classroom and mental health interventions. Neither child gender nor ADHD subtype influenced effectiveness ratings. Results are discussed in regard to the urgent need for urban educators to experience greater success in their efforts to implement interventions for students with ADHD and for research focused on the unique needs of children residing in urban, low-income communities.

Sluggish vagal brake reactivity to physical exercise challenge in children with selective mutism

Cardiovascular response patterns to laboratory-based social and physical exercise challenges were evaluated in 69 children and adolescents, 20 with selective mutism (SM), to identify possible neurophysiological mechanisms that may mediate the behavioral features of SM. Results suggest that SM is associated with a dampened response of the vagal brake to physical exercise that is manifested as reduced reactivity in heart rate and respiration. Polyvagal theory proposes that the regulation of the vagal brake is a neurophysiological component of an integrated social engagement system that includes the neural regulation of the laryngeal and pharyngeal muscles. Within this theoretical framework, sluggish vagal brake reactivity may parallel an inability to recruit efficiently the structures involved in speech. Thus, the findings suggest that dampened autonomic reactivity during mobilization behaviors may be a biomarker of SM that can be assessed independent of the social stimuli that elicit mutism.

Quality control and the practice of clinical psychology

Abstract Because of current health care reforms, quality control, accountability, and cost-effectiveness have become important issues in the practice of clinical psychology. It is imperative that practicing clinicians begin to evaluate their services to assess whether they demonstrate high quality and cost-effectiveness, as well as a continued commitment to qualify improvement. Demings (1986) approach to quality control is discussed as a useful strategy for improving effectiveness in the practice of clinical psychology. This approach emphasizes the process of identification of the client population, improvements through incremental processes, and evaluation of outcomes. Organizational Behavior Management (OBM) techniques are also reviewed as useful ways in which to supplement and improve on Demings approach to quality control. Science and quality control are discussed as being inherently coherent. The scientist—practitioner model dictates that services provided to clients should be rigorously evaluated. Various procedures for evaluating the quality of services provided in clinical practice are discussed.

Implementing Effective Youth Violence Prevention Programs in Community Settings

The past decade has seen remarkable growth in the field of youth violence prevention. There is an increased understanding of the biological and contextual factors that place youth at risk for violence, enhanced awareness of the importance of identifying protective factors, and a proliferation of rigorously designed empirical studies that has allowed for the categorization of many prevention efforts as efficacious, promising, or ineffective. As society’s view of youth violence shifts from one that perceives youth violence solely as a juvenile justice issue to a broader perspective that recognizes youth violence as a public health issue, greater attention is being focused on: clarifying the nature of youth violence and patterns in its occurrence and prevalence; using epidemiological methodologies to identify putative causal, risk, and protective factors; developing and evaluating the effectiveness and generalizability of interventions; and widespread dissemination of effective interventions (U.S. Department of Health and Human Services (USDHHS), 2001). All these factors combine to set the stage in the coming decade for even greater progress in understanding the roots of youth violence and finding ways to prevent and treat it. A major challenge that remains to be addressed by researchers, practitioners, and policy makers alike is to find ways to facilitate the utilization