Tommy Chou

Do cavies talk? The effect of anthropomorphic picture books on children's knowledge about animals

Many books for young children present animals in fantastical and unrealistic ways, such as wearing clothes, talking and engaging in human-like activities. This research examined whether anthropomorphism in childrens books affects childrens learning and conceptions of animals, by specifically assessing the impact of depictions (a bird wearing clothes and reading a book) and language (bird described as talking and as having human intentions). In Study 1, 3-, 4-, and 5-year-old children saw picture books featuring realistic drawings of a novel animal. Half of the children also heard factual, realistic language, while the other half heard anthropomorphized language. In Study 2, we replicated the first study using anthropomorphic illustrations of real animals. The results show that the language used to describe animals in books has an effect on childrens tendency to attribute human-like traits to animals, and that anthropomorphic storybooks affect younger childrens learning of novel facts about animals. These results indicate that anthropomorphized animals in books may not only lead to less learning but also influence childrens conceptual knowledge of animals.

Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt

BACKGROUND: The majority of research on terrorism-exposed youth has examined large-scale terrorism with mass casualties. Limited research has examined children’s reactions to terrorism of the scope of the Boston Marathon bombing. Furthermore, the extraordinary postattack interagency manhunt and shelter-in-place warning made for a truly unprecedented experience in its own right for families. Understanding the psychological adjustment of Boston-area youth in the aftermath of these events is critical for informing clinical efforts. METHODS: Survey of Boston-area parents/caretakers (N = 460) reporting on their child’s experiences during the attack week, as well as psychosocial functioning in the first 6 attack months. RESULTS: There was heterogeneity across youth in attack- and manhunt-related experiences and clinical outcomes. The proportion of youth with likely attack/manhunt-related posttraumatic stress disorder (PTSD) was roughly 6 times higher among Boston Marathon–attending youth than nonattending youth. Attack and manhunt experiences each uniquely predicted 9% of PTSD symptom variance, with manhunt exposures more robustly associated than attack-related exposures with a range of psychosocial outcomes, including emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems. One-fifth of youth watched >3 hours of televised coverage on the attack day, which was linked to PTSD symptoms, conduct problems, and total difficulties. Prosocial behavior and positive peer functioning buffered the impact of exposure. CONCLUSIONS: Clinical efforts must maintain a broadened focus beyond simply youth present at the blasts and must also include youth highly exposed to the intense interagency pursuit and manhunt. Continued research is needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities.

Caregiver distress, shared traumatic exposure, and child adjustment among area youth following the 2013 Boston Marathon bombing.

BACKGROUND Disasters are associated with myriad negative outcomes in youth, including posttraumatic stress disorder and related psychopathology. Prior work suggests links between caregiver distress and child mental health outcomes following community traumas, but the extent to which caregiver distress is directly linked to post-disaster child functioning, or whether such associations may simply be due to shared traumatic exposure, remains unclear. METHODS The current study examined relationships among caregiver distress, caregiver-child shared traumatic exposure, and child outcomes in Boston-area families (N=460) during the six months following the 2013 Boston Marathon bombing. Parents completed surveys about their and their child׳s potentially traumatic experiences during the bombing and subsequent manhunt. Post-attack caregiver distress and child psychological functioning were also assessed. RESULTS After accounting for caregiver-child shared traumatic exposure, significant associations were retained between caregiver distress and child functioning across several domains. Furthermore, after accounting for caregiver traumatic exposure, caregiver distress moderated relationships between child traumatic exposure and child posttraumatic stress and conduct problems, such that associations between child traumatic exposure and child posttraumatic stress and conduct problems were particularly strong among children of highly distressed caregivers. LIMITATIONS The cross-sectional design did not permit evaluations across time, and population-based methods were not applied. CONCLUSIONS Findings clarify links between caregiver distress and child psychopathology in the aftermath of disaster and can inform optimal allocation of clinical resources targeting disaster-affected youth and their families.

Event-Related Household Discussions Following the Boston Marathon Bombing and Associated Posttraumatic Stress Among Area Youth

Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately postdisaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages 4 to 19 following the Marathon bombing (N = 460). Caregivers completed surveys 2 to 6 months postattack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children’s PTS. Specifically, after controlling for children’s direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty.

Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered parent–child interaction therapy (I-PCIT).

Objective: Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method: Racially/ethnically diverse children ages 3–5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent–child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results: Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed “treatment response” after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show “treatment response” at 6-month follow-up. Both treatments had significant effects on children’s symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment “excellent response” was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion: Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training.

Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial.

Objective: Despite advances in supported treatments for early onset obsessive–compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method: RCT comparing VTC-delivered family based cognitive–behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4–8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. “Excellent response” was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results: Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed “excellent response,” and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed “excellent response.” Significant condition differences were not found across outcomes. Conclusions: VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children’s geographic proximity to quality care.

ADJUSTMENT AMONG CHILDREN WITH RELATIVES WHO PARTICIPATED IN THE MANHUNT FOLLOWING THE BOSTON MARATHON ATTACK

Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter‐in‐place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt‐related experiences and post‐attack functioning, such work does little to identify the specific needs of a particularly vulnerable population—i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts.

Consumer Smartphone Apps Marketed for Child and Adolescent Anxiety: A Systematic Review and Content Analysis

Anxiety disorders are collectively the most prevalent mental health problems affecting youth. To increase the reach of mental health care, recent years have seen increasing enthusiasm surrounding mobile platforms for expanding treatment delivery options. Apps developed in academia and supported in clinical trials are slow to reach the consumer marketplace. Meanwhile, proliferation of industry-developed apps on consumer marketplaces has been high. The present study analyzed content within mobile products prominently marketed toward consumers for anxiety in youth. Systematic inventory of the Google Play Store and Apple Store using keyword searches for child and adolescent anxiety yielded 121 apps, which were evaluated on the basis of their descriptive characteristics, mobile functionalities, and adherence to evidence-based treatment principles. Findings revealed that evidence-based treatment content within the sample is scant and few comprehensive anxiety self-management apps were identified. Advanced features that leverage the broader functionalities of smartphone capabilities (e.g., sensors, ecological momentary assessments) were rarely present. Findings underscore the need to increase the prominence and accessibility of quality child anxiety intervention products for consumers. Strategies for improving marketing of supported apps to better penetrate consumer markets are discussed.

Videoteleconferencing Early Child Anxiety Treatment: A Case Study of the Internet-Delivered PCIT CALM (I-CALM) Program

ABSTRACT Anxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Although the vast majority of supported programs for child anxiety focus on youth 7 years of age and older, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, that is, the Parent–Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6-year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient’s anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed.

Cognitive-Behavioral Therapy for Children and Adolescents

Children’s mental health problems are highly prevalent and impose enormous burdens at the individual, family, and societal level. Fortunately, the past few decades have witnessed tremendous advances in the development and evaluation of developmentally sensitive cognitive behavioral procedures with demonstrated success in treating a considerable share of mental health problems presenting in youth. In this chapter, we provide a brief overview of the cognitive behavioral treatment (CBT) model for youth mental health problems, followed by a discussion of key developmental considerations and distinguishing attributes of CBT when targeting mental health problems in youth. We then turn attention to how CBT differentially addresses specific domains of child mental health problems and review major advances and innovations in recent years that hold great promise for meaningfully expanding the reach and quality of CBT for an even a larger proportion of affected children and adolescents. These innovations include the development of transdiagnostic, modular, and intensive CBT formats, as well as the promising role of technology for improving the accessibility of CBT for traditionally underserved child populations. We conclude by highlighting areas in need of continued empirical attention and lay out an agenda for future research seeking to optimize the public health impact of CBT procedures for redressing children’s mental health problems.