Sharon E. Williams

Pivotal Response Group Treatment Program for Parents of Children with Autism.

The number of children diagnosed with autism spectrum disorders is increasing, necessitating the development of efficient treatment models. Research has demonstrated that parent-delivered behavioral interventions are a viable treatment model; however, little research has focused on teaching parents in groups. The aim of this study was to demonstrate that parents can learn Pivotal Response Training (PRT) in group therapy, resulting in correlated gains in children’s language. Baseline and post-treatment data were obtained and examined for changes in (a) parent fidelity of PRT implementation, and (b) child functional verbal utterances. Significant differences were observed for both variables. These findings suggest that parents can learn PRT in a group format, resulting in correlated child language gains, thus future controlled studies are warranted.

Recovery in pediatric brain injury: is psychostimulant medication beneficial?

Objective:To assess the effects of methylphenidate on attention, memory, behavior, processing speed, and psychomotor skills of children with closed head injuries. Design:Double-blind, placebo-controlled, crossover design. Setting:An outpatient facility of a childrens hospital medical center. Patients:Ten pediatric subjects identified through chart review. Subjects met baseline scores for hyperactivity (Conners Hyperactivity Index 560) and intellectual functioning (Verbal Intelligence Quotient £70) and achieved minimal scores on two psychometric tests. All subjects evidenced head injury by focal lesions on computed tomography scan and/or sequelae reported at the time of injury. Severity of injury ranged from mild to severe. All subjects were medically stable at the time of testing. Mean time post injury was 2 years, 8 months. Intervention:Administration of methylphenidate and placebo. Main Outcome Measures:Percentage change in scores was calculated to assess differences between baseline and end of methylphenidate/ placebo trials. Results:No significant differences between methylphenidate and placebo on measures assessing behavior, attention, memory, and processing speed. Conclusions:The results of the study call into question the effectiveness of methylphenidate in the pediatric head injury population.

Adult psychosocial outcome in early-treated phenylketonuria

Concerns about the psychosocial risk of adults with early-treated phenylketonuria (ETPKU) are predicated on four sources of scientific data: (1) consistent documentation of increased behavioural risk in children with ETPKU; (2) recent evidence of neurocognitive impairment in adults with ETPKU; (3) reports of neuroimaging abnormalities in adults with ETPKU; and (4) preliminary evidence of increased rates of psychiatric disturbance in this population. We studied the psychosocial adjustment of 25 patients, aged 18 years and older, with ETPKU. On most pscyhosocial outcome measures, patients were indistinguishable from 15 sibling controls. However, on a self-report inventory of psychiatric symptoms, 20% of the patients demonstrated significant morbidity. Psychosocial outcome of these patients was unrelated to concurrent or historical biological dietary disease factors, unlike neurocognitive outcome. A strong relationship was demonstrated, however, between neurocognitive measures and psychosocial morbidity. These findings indicate that a significant minority of patients with ETPKU develop psychosocial difficulties with multiple clinical elevations on a psychiatric inventory. However, most adults with ETPKU cope with the challenges of young adulthood with the same degree of success as their unaffected siblings. Neuropsychological surveillance during childhood and adolescence is important in identifying patients at risk for both neurocognitive and psychosocial morbidity.

Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation

OBJECTIVES The purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT). DESIGN A prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement. METHODS Thirty-five mothers of children who had undergone HSCT were interviewed at the time of their childs HSCT and 3 months post-bereavement. RESULTS Mothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress. CONCLUSIONS This study provides partial support for the role of meaning in adjustment to loss.

Brief cognitive–behavioral intervention for maternal depression and trauma in the neonatal intensive care unit: A pilot study†

Parents of hospitalized premature infants are at risk for developing psychological symptoms. This randomized controlled pilot study examined the effectiveness of a brief cognitive-behavioral intervention in reducing traumatic and depressive symptoms in mothers 1 month after their infants discharge from the hospital. Fifty-six mothers were randomly assigned to the intervention or control group. Results showed that mothers experienced high levels of symptoms initially and at follow-up. At follow-up, there was a trend for mothers in the intervention group to report lower levels of depression (p = .06; Cohens f = .318), but levels of traumatic symptoms were similar for both groups. Brief psychological interventions may reduce depressive symptoms in this population. Estimates of the effect sizes can be used to inform future intervention studies.

Impact of Pivotal Response Training Group Therapy on Stress and Empowerment in Parents of Children with Autism.

Parents of children with autism are increasingly being considered as primary agents of intervention for their children. The goal of this study was to evaluate whether participating in a pivotal response training (PRT) group therapy program for parents of children with autism influenced related aspects of parents’ lives, namely, their levels of stress and empowerment. Seventeen families participated in a 10-week therapy group designed to train parents to use PRT, with a specific focus on their children’s language deficits. Measures of empowerment and stress were obtained at baseline and at the end of the trial. Ratings on the Parenting Stress Index/Short Form and the Family Empowerment Scale showed significant changes from pre- to posttreatment, indicating that parents felt higher levels of empowerment and lower levels of stress after the 10-week group program. Notably, stress related to parent–child interactions was most reduced. Possible causal factors and implications are discussed.

Amantadine treatment following traumatic brain injury in children

Primary objective: The focus of this paper is to review the current literature on the use of amandatine in children who have sustained a head injury. Main outcomes and results: A MEDLINE search was conducted and yielded five papers. They were composed of prospective, retrospective and case study designs. Dosage use and side effect profiles were consistent with expected norms. Efficacy was measures primarily by alertness and arousal and positive results were found for all studies on these dimensions. Behavioural and cognitive measures of outcome yielded mixed results. Conclusions: The studies reviewed for this paper suggest that amantadine is clinically beneficial for children who have sustained head injuries. Double blind placebo controlled trials with larger sample sizes are needed to further substantiate these findings.

Perceived partner critical and avoidant behaviors as predictors of anxious and depressive symptoms among mothers of children undergoing hemopaietic stem cell transplantation

This prospective study examined the role of perceived partner criticism and avoidance in the anxiety and depressive symptoms of 148 mothers of children undergoing hemopaietic stem cell transplantation (HSCT). The roles of indicators of transplantation risk and posttransplantation medical course were also examined. Perceived partner criticism (e.g., criticizing coping efforts) and perceived partner avoidance (e.g., changing the topic), objective indicators of transplantation risk, and anxiety and depressive symptoms were assessed at the time of HSCT and again 3 and 6 months later. Growth curve modeling analyses indicated that perceived partner criticism was associated with higher average depressive symptoms. However, perceived partner criticism did not predict changes in mothers anxiety. Contrary to predictions, perceived partner avoidance was associated with decreases in maternal anxiety.

Psychiatric Assessment of Victims of Adolescent Dating Violence in a Primary Care Clinic

Dating violence in the adolescent population is a significant problem, which warrants concern and focus. As many as one-third of adolescents have experienced dating violence in their relationships. This article outlines many of the developmental and experiential factors that influence the likelihood that adolescents will encounter violence in their relationships. Mental health clinicians, physicians, nurses, social workers, and others who work with adolescents in the health field have a unique opportunity to identify and respond to this type of violence involving their patients. This article outlines the ways in which health care professionals can assess patients for this type of violence and when and how to offer assistance and referrals.

Practitioners’ Attitudes Toward the Use of Treatment Progress and Outcomes Data in Child Mental Health Services

This study focused on practitioners’ attitudes toward child mental health services data collection and outcomes measurement in university-based and community-based clinics. It is relevant to the burgeoning field of empirically based mental health therapy management because it examines one potential barrier to psychotherapy and pharmacotherapy strategies (i.e., practitioners’ attitudes toward outcomes measurement) that are informed by real-time, clinically relevant data. Two site differences were noted regarding the utility of specific questionnaires and the perceived burden of conducting outcomes measurement. At both sites, practitioners held positive attitudes about outcomes measurement. Compared with psychologists and other child mental health specialists, psychiatrists had less favorable attitudes toward outcomes evaluation. Practitioners who rated outcomes evaluation as more important also perceived less burden associated with such evaluation efforts. Increased understanding of the utility of systematic clinical data collection is more likely to occur in an organizational culture in which treatment progress and outcomes measurement is integral to clinical work.