Stephen R. Boggs

Evidence-Based Psychosocial Treatments for Children and Adolescents With Disruptive Behavior

This article reviews the literature from 1996 to 2007 to update the 1998 Brestan and Eyberg report on evidence-based psychosocial treatments (EBTs) for child and adolescent disruptive behavior, including oppositional defiant disorder and conduct disorder. Studies were evaluated using criteria for EBTs developed by the task force on promotion and dissemination of psychological procedures (Chambless et al., 1998; Chambless et al., 1996). Sixteen EBTs were identified in this review, up from 12 in the earlier report, and 9 “possibly efficacious” treatments (Chambless & Hollon, 1998) were identified as well. This article describes the EBTs and their evidence base and covers research on moderators and mediators of treatment outcome, as well as the clinical representativeness and generalizability of the studies. Best practice recommendations from the current evidence base also are offered, as well as calls for future research that increases understanding of the moderators and mechanisms of change for children and adolescents with disruptive behavior disorders.

Development and Validation of the Pediatric Oncology Quality of Life Scale.

This study describes the development of a 21-item, parent report measure for assessing the quality of life (QOL) of children with cancer. The Pediatric Oncology Quality of Life Scale (POQOLS) provides a total score and three factor scores that assess physical function and role restriction, emotional distress, and reaction to current medical treatment. Internal consistency reliabilities of the total scale and the three factors were high, as was interparent agreement. In addition, POQOLS scores demonstrated good concurrent and discriminant relationships with scores on measures of adjustment hypothesized to covary with the dimensions of QOL assessed.

Outcomes of Parent-Child Interaction Therapy: A Comparison of Treatment Completers and Study Dropouts One to Three Years Later

ABSTRACT Using a quasi-experimental design, this study examined longitudinal outcomes for families previously enrolled in a study of Parent-Child Interaction Therapy (PCIT), a treatment program for young children with disruptive behavior disorders. Comparisons were made between 23 families who completed treatment and 23 families who dropped out of the study before completing treatment, using a structured diagnostic interview, and several parent-report measures. Length of follow-up for both groups ranged from 10 to 30 months after the initial assessment, with the average length of follow-up just under 20 months. Results indicated consistently better long-term outcomes for those who completed treatment than for study dropouts. These results highlight the need to identify salient predictors of treatment engagement and retention to maximize outcomes for young children.

Predicting Outcome in Parent-Child Interaction Therapy Success and Attrition

This study explored predictors of treatment response and attrition in Parent-Child Interaction Therapy (PCIT). Participants were 99 families of 3- to 6-year-old children with disruptive behavior disorders. Multiple logistic regression was used to identify those pretreatment child, family, and accessibility factors that were predictive of success or attrition. For all study participants, waitlist group assignment and maternal age were the significant predictors of outcome. For treatment participants (study participants excluding those who dropped out after the initial evaluation but before treatment began), only maternal ratings of parenting stress and maternal inappropriate behavior during parent-child interactions were significant predictors of treatment outcome. These results suggest that for treatment studies of disruptive preschoolers, the benefits of using a waitlist control group may be outweighed by the disproportionate number of dropouts from this group. Once families begin PCIT, however, parent-related variables become salient in predicting treatment outcome.

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study.

Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.

Stage II breast cancer : Differences between four coping patterns in side effects during adjuvant chemotherapy

Fifty-six women with stage II breast cancer receiving adjuvant chemotherapy were recruited for a study evaluating and comparing coping patterns for differences in physical and psychological side effects during treatment with adjuvant chemotherapy. Cluster analyses were used to split women into confrontive, avoidant-confrontive, avoidant-resigned, and resigned coping clusters. Side-effect measurements were taken on the day of adjuvant chemotherapy infusion and 3 and 7 days later. Repeated measures ANCOVAs indicated that coping clusters predicted significant variance in physical, psychological, and total side effects when variance in covariates was held constant. Confrontive subjects reported significantly fewer psychological and physical symptoms than avoidant-confrontive and avoidant-resigned copers. Confrontive copers also reported fewer side effects than resigned copers, but this difference was not significant when differences in covariate distributions were controlled. Particularly robust differences were noted when confrontive copers were compared with avoidant-confrontive copers. Results suggest that a critical component in optimal coping may be a willingness to discuss and think about illness.

Social support, family variables, and compliance in renal transplant children.

The relationship between family functioning, social support, and medication compliance in 32 renal transplant children and their parents was examined. Results indicated that children whose fathers gave more emotional support or were more informative were less compliant with azathioprine and cyclosporine (P<0.05 for both). Children from families experiencing numerous stresses were also found to be less compliant with azathioprine (P<0.05). Finally, compared with older children, younger children were found to be less compliant with cyclosporine (P<0.005). Implications for predicting child adherence and for future research relating to compliance with multidrug regimens are discussed.

Verbal Memory Abilities of Children With Brain Tumors

Several critical neuroanatomical structures and pathways for memory performance are located in the third ventricle region. This led us to predict that verbal memory abilities would be more impaired in children treated for third ventricle tumors compared to those treated for cerebellar tumors. Archival data was obtained from 24 pediatric patients with third ventricle region tumors and 18 pediatric patients with cerebellar tumors. Neuroradiological verifications of tumor involvement and hydrocephalus severity (i.e., Evans Index) on preoperative scans and MRIs proximal to the time of the neuropsychological evaluation were conducted. The potential confounds of hydrocephalus severity, seizure medication, age, radiation treatment, and chemotherapy were addressed. Verbal IQ was comparable between tumor groups and in the Average range. The third ventricle region group performed significantly worse on list learning and delayed list recall compared to the cerebellar group. Their mean performance was in the clinically impaired range on both trials. The third ventricle region tumor group performed better than the cerebellar tumor group on Digit Span, a basic repetition, attention span task. These findings support the hypothesis that pediatric patients with third ventricle region brain tumors are more likely to be impaired on verbal recall tasks compared to pediatric patients with cerebellar brain tumors. In contrast, patients who were treated for cerebellar tumors were more impaired on the basic repetition, attention span task compared to patients who were treated for third ventricle tumors. Future studies should examine the specific neuroanatomical structures and pathways that are damaged and may influence differential cognitive impairments in children.

Cluster analysis of the Medical Coping Modes Questionnaire : evidence for coping with cancer styles ?

A number of researchers have attempted to understand how individuals cope with having cancer. Unfortunately, this voluminous literature has suffered from a number of problems common to other pre-paridigmic disciples. Studies are generally isolated and fail to build upon other research in the literature. In addition, no guiding theory or conceptualization exists that helps to explain and describe the richness and complexity of observed clinical phenomena. With the understanding that coping with cancer is multidimensional, some researchers have attempted to group coping responses into dominant styles. In an effort to better understand the results of this approach, we performed a cluster analysis on 117 responses to a three scale questionnaire, the Medical Coping Modes Questionnaire. Results indicated that subjects can be grouped into one of four coping categories: confrontive, avoidant, resigned, or with a nondominant style. Future research is needed to explore how these styles influence quality of life during and following treatment.

Psychometric Properties and Reference Point Data for the Revised Edition of the School Observation Coding System

The psychometric properties of a new observation coding system for childrens disruptive classroom behavior were evaluated. The Revised Edition of the School Observation Coding System (REDSOCS) was used to observe 51 young children clinic-referred for conduct-disordered behavior and 182 nonreferred children from the classrooms of the referred children. Reference point data for the REDSOCS categories with preschoolers were obtained from the sample of nonreferred children. Interobserver reliability and concurrent validity of the three REDSOCS categories with teacher rating scales of oppositional behavior and hyperactivity were demonstrated. Initial evidence of convergent and discriminant validity was established through correlations of the REDSOCS categories with the subscales of the Revised Conners Teacher Rating Scale. Differences in REDSOCS scores between the nonreferred children and children referred for school behavior problems provided